Provider Demographics
NPI:1689169153
Name:BURGER, PATRICIA (MT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BURGER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT
Mailing Address - Street 1:251 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5210
Mailing Address - Country:US
Mailing Address - Phone:401-453-4263
Mailing Address - Fax:
Practice Address - Street 1:251 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5210
Practice Address - Country:US
Practice Address - Phone:401-453-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02484225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist