Provider Demographics
NPI:1902141815
Name:BURGENER, PATRICIA E (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:E
Last Name:BURGENER
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4885
Mailing Address - Country:US
Mailing Address - Phone:772-794-1234
Mailing Address - Fax:772-794-7890
Practice Address - Street 1:1285 36TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4885
Practice Address - Country:US
Practice Address - Phone:772-794-1234
Practice Address - Fax:772-794-7890
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT7595225100000X
FLPT20471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist