Healthcare Provider Details

I. General information

NPI: 1487200895
Provider Name (Legal Business Name): BRIANA BURCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 SW 11TH CT
DELRAY BEACH FL
33445-6013
US

IV. Provider business mailing address

1526 WINDSHIP CIR
WEST PALM BEACH FL
33414-8049
US

V. Phone/Fax

Practice location:
  • Phone: 561-454-1130
  • Fax:
Mailing address:
  • Phone: 561-310-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: