Provider Demographics
NPI:1326623935
Name:BURNINGHAM, NATALIE (MT-BC, IBDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BURNINGHAM
Suffix:
Gender:F
Credentials:MT-BC, IBDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9819
Mailing Address - Country:US
Mailing Address - Phone:303-887-1070
Mailing Address - Fax:
Practice Address - Street 1:485 MEADOW LN
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9819
Practice Address - Country:US
Practice Address - Phone:303-887-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X, 246X00000X, 332B00000X
UT9203390-4010225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies