Provider Demographics
NPI:1003941618
Name:BURGAN, BETH ANN (NCTMB)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:BURGAN
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W 43RD ST
Mailing Address - Street 2:#206
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1643
Mailing Address - Country:US
Mailing Address - Phone:612-927-5525
Mailing Address - Fax:
Practice Address - Street 1:2720 W 43RD ST
Practice Address - Street 2:#206
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1643
Practice Address - Country:US
Practice Address - Phone:612-927-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist