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General NPI Number Information
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NPI Number | 1942859814
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Entity Type | Individual
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Provider Name | KRISTEN BURGESS
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 29 ATLANTIC AVE
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City | OCEAN VIEW
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State | DE
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Zip | 19970-9155
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Country | US
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Telephone | 919-258-2714
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Fax |
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Provider Business Mailing Address
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Address Line | 350 NEW FIDELITY CT
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City | GARNER
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State | NC
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Zip | 27529-2665
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Country | US
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Telephone | 919-258-2714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0004112
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License Number State | DE
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