Provider Demographics
NPI:1215388970
Name:BURGAN, CHEREE (LMT, AC)
Entity Type:Individual
Prefix:
First Name:CHEREE
Middle Name:
Last Name:BURGAN
Suffix:
Gender:F
Credentials:LMT, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2410
Mailing Address - Country:US
Mailing Address - Phone:907-529-9033
Mailing Address - Fax:
Practice Address - Street 1:401 W INTERNATIONAL AIRPORT RD STE 11
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1168
Practice Address - Country:US
Practice Address - Phone:907-276-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist