Provider Demographics
NPI:1134446008
Name:BURGESS, DEE ANN (PTA, WCC)
Entity type:Individual
Prefix:MRS
First Name:DEE
Middle Name:ANN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PTA, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 OLD BRUCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3889
Mailing Address - Country:US
Mailing Address - Phone:812-886-4677
Mailing Address - Fax:812-886-4678
Practice Address - Street 1:7465 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6564
Practice Address - Country:US
Practice Address - Phone:317-788-3000
Practice Address - Fax:317-788-3005
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002021A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN06002021AOtherPROFESSIONAL LICENSE
IN6150719OtherWOUND CARE CERTIFIED