Provider Demographics
NPI:1306897632
Name:BURGA, JOAN E (PT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:BURGA
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 1:445 TURNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5831
Mailing Address - Country:US
Mailing Address - Phone:985-871-0606
Mailing Address - Fax:
Practice Address - Street 1:1740 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3110
Practice Address - Country:US
Practice Address - Phone:985-727-0097
Practice Address - Fax:985-727-5006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H623CR79Medicare ID - Type UnspecifiedPT