Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003941618 |
---|---|
Provider Name | Ms. Beth Ann Burgan |
First Address | Minneapolis, MN 55410-1643 |
Second Address | Minneapolis, MN 55410-1643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 03/02/2014 |