Individual
IAN SPENCER BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
305 MAPLE ST, EAST LONGMEADOW, MA 01028-2773
(413) 525-6361
Mailing address
13 KYLE ST # DD, BRUNSWICK, ME 04011-7313
(207) 751-8664
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2251000000X
MA
Other
Enumeration date
06/09/2022
Last updated
06/22/2022
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