Provider Demographics
NPI:1528069853
Name:BURCHILL, HEATHER J (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:BURCHILL
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 1:1808 128TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:ND
Mailing Address - Zip Code:58064-9612
Mailing Address - Country:US
Mailing Address - Phone:701-668-2387
Mailing Address - Fax:
Practice Address - Street 1:1808 128TH AVE SE
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:ND
Practice Address - Zip Code:58064-9612
Practice Address - Country:US
Practice Address - Phone:701-668-2387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist