Provider Demographics
NPI:1891992244
Name:BURGESS, HEIDI HANSEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:HANSEN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10199 SAMSON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49620-9592
Mailing Address - Country:US
Mailing Address - Phone:231-269-4359
Mailing Address - Fax:
Practice Address - Street 1:10199 SAMSON WOODS DR
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:MI
Practice Address - Zip Code:49620-9592
Practice Address - Country:US
Practice Address - Phone:231-269-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist