Provider Demographics
NPI:1366802225
Name:BERGEY, ALYSSA R (MT-BC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:BERGEY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 E CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1011
Mailing Address - Country:US
Mailing Address - Phone:215-588-9955
Mailing Address - Fax:
Practice Address - Street 1:1987 E CHERRY LN
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1011
Practice Address - Country:US
Practice Address - Phone:215-588-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12287225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist