Provider Demographics
NPI:1003818691
Name:BURGGRAAF, MICHAEL J (PT MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BURGGRAAF
Suffix:
Gender:M
Credentials:PT MS
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Mailing Address - Street 1:2001 WESTOWN PKWY
Mailing Address - Street 2:STE 107
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1540
Mailing Address - Country:US
Mailing Address - Phone:515-440-3439
Mailing Address - Fax:515-440-3832
Practice Address - Street 1:516 NILE KINNICK DR. SOUTH
Practice Address - Street 2:STE B
Practice Address - City:ADEL
Practice Address - State:IA
Practice Address - Zip Code:50003-1831
Practice Address - Country:US
Practice Address - Phone:515-993-5599
Practice Address - Fax:515-993-1964
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-09-28
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Provider Licenses
StateLicense IDTaxonomies
IA03285225100000X
IA3285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83633Medicare UPIN