Individual
ROGER LEE BURTRAW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4570 CHURCHILL ST STE 300, SHOREVIEW, MN 55126-2274
(651) 481-1071
(651) 481-0042
Mailing address
4570 CHURCHILL ST STE 300, SHOREVIEW, MN 55126-2274
(651) 481-1071
(651) 481-0042
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9863
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588062988
—
MN
Enumeration date
12/17/2014
Last updated
02/12/2018
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