Provider Demographics
NPI:1003322157
Name:BURROWS-ALLEN, MIAPATRICE
Entity Type:Individual
Prefix:MRS
First Name:MIAPATRICE
Middle Name:
Last Name:BURROWS-ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5910
Mailing Address - Country:US
Mailing Address - Phone:504-628-6394
Mailing Address - Fax:
Practice Address - Street 1:3827 SPENCER ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5910
Practice Address - Country:US
Practice Address - Phone:504-628-6394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11701431332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty