Individual
LANAE LYNN BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1787 E FORT UNION BLVD, SALT LAKE CITY, UT 84121-2850
(801) 883-8203
Mailing address
551 N 200 E APT 305, PROVO, UT 84606-2738
(928) 201-9992
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
13779955-8019
UT
Other
Enumeration date
02/05/2024
Last updated
02/05/2024
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