Provider Demographics
NPI:1427492420
Name:FREEBURN, BEVERLY VALENTINA (MT)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:VALENTINA
Last Name:FREEBURN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4907
Mailing Address - Country:US
Mailing Address - Phone:517-303-5849
Mailing Address - Fax:
Practice Address - Street 1:1770 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4907
Practice Address - Country:US
Practice Address - Phone:517-303-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist