Provider Demographics
NPI:1932597804
Name:BURGIN, HEIDE (ATC)
Entity Type:Individual
Prefix:
First Name:HEIDE
Middle Name:
Last Name:BURGIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 W POINTE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8554
Mailing Address - Country:US
Mailing Address - Phone:904-537-6982
Mailing Address - Fax:
Practice Address - Street 1:2439 WILLWOOD DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3904
Practice Address - Country:US
Practice Address - Phone:904-537-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer