Provider Demographics
NPI:1407203664
Name:BURGIN, ELIZABETH JAY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JAY
Last Name:BURGIN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:894 UNION STATION PKWY
Mailing Address - Street 2:APT 10107
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5247
Mailing Address - Country:US
Mailing Address - Phone:210-607-0825
Mailing Address - Fax:
Practice Address - Street 1:894 UNION STATION PKWY
Practice Address - Street 2:APT 10107
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5247
Practice Address - Country:US
Practice Address - Phone:210-607-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT52452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer