Healthcare Provider Details

I. General information

NPI: 1134446008
Provider Name (Legal Business Name): DEE ANN BURGESS PTA, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 MADISON AVE
INDIANAPOLIS IN
46227-6564
US

IV. Provider business mailing address

3801 OLD BRUCEVILLE RD
VINCENNES IN
47591-3889
US

V. Phone/Fax

Practice location:
  • Phone: 317-788-3000
  • Fax: 317-788-3005
Mailing address:
  • Phone: 812-886-4677
  • Fax: 812-886-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002021A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: