Basic Information
Provider Information | |||||||||
NPI: | 1184624868 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BERGER GRANT | ||||||||
FirstName: | MARSHA | ||||||||
MiddleName: | ELLEN | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS PT OCJ | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 676 DE KALB PIKE | ||||||||
Address2: | STE 205 | ||||||||
City: | BLUE BELL | ||||||||
State: | PA | ||||||||
PostalCode: | 194221223 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6102700380 | ||||||||
FaxNumber: | 6102700874 | ||||||||
Practice Location | |||||||||
Address1: | 1500 HORIZON DR | ||||||||
Address2: | STE 102E | ||||||||
City: | CHALFONT | ||||||||
State: | PA | ||||||||
PostalCode: | 189143966 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157120300 | ||||||||
FaxNumber: | 2157129040 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT005482L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.