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General NPI Number Information
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NPI Number | 1972935559
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Entity Type | Individual
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Provider Name | MOLLIE-JEAN BURGESS MSED, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 800 E CITY HALL AVE SUITE 800
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City | NORFOLK
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State | VA
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Zip | 23510-2723
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Country | US
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Telephone | 401-741-0845
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 LONGDALE DR APT 101
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City | NORFOLK
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State | VA
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Zip | 23513-4731
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Country | US
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Telephone | 401-741-0845
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126001695
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License Number State | VA
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