Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 15077 | NC |
N | 2251S0007X | Physical Therapist - Sports | 15077 | NC |
N | 2251X0800X | Physical Therapist - Orthopedic | 15077 | NC |
NPI | 1548235658 |
---|---|
Provider Name | Mrs. Melissa Dawn Burgemeister |
First Address | Winston Salem, NC 27103-7114 |
Second Address | Winston Salem, NC 27103-7114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 04/09/2014 |