Luke Derek Casona Berdin, PT, DPT | |
717 E Alfred St, Weyauwega, Wi 54983, Weyauwega, WI 54983 | |
(920) 867-3121 | |
Not Available |
Full Name | Luke Derek Casona Berdin |
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Gender | Male |
Speciality | Physical Therapist |
Location | 717 E Alfred St, Weyauwega, Wi 54983, Weyauwega, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1962978700 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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225100000X | Physical Therapist | 14132-24 (Wisconsin) | Primary |
Provider Name | Aegis Group Practice Llc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1275073363 PECOS PAC ID: 5193036432 Enrollment ID: O20170614002978 |
Mailing Address | Practice Location Address |
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Luke Derek Casona Berdin, PT, DPT 1336 Stone Ridge Rd Apt 57, Waupaca, WI 54981-8639 Ph: (929) 273-9321 | Luke Derek Casona Berdin, PT, DPT 717 E Alfred St, Weyauwega, Wi 54983, Weyauwega, WI 54983 Ph: (920) 867-3121 |
Mrs. Cynthia May Wendt, PTA Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 717 E. Alfred St. Weyauwaga,, 717 E. Alfred, Weyauwega, WI 54983 Phone: 920-867-3121 Fax: 920-867-3997 | |
Mr. Craig M Gorst, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 717 E Alfred St, Weyauwega, WI 54983 Phone: 920-867-3121 Fax: 920-867-3997 |