Basic Information
| Provider Information | |||||||||
| NPI: | 1578727020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | ARNOLD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 E BIDWELL ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956303452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169835925 | ||||||||
| FaxNumber: | 9169835932 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 GOLDEN CENTER DR | ||||||||
| Address2: | |||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956676260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306211100 | ||||||||
| FaxNumber: | 9169854105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2008 | ||||||||
| LastUpdateDate: | 07/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5231 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.