Healthcare Provider Details

I. General information

NPI: 1609063569
Provider Name (Legal Business Name): JANET BURUCHIAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 W ATLANTIC AVE SUITE C
DELRAY BEACH FL
33484-8170
US

IV. Provider business mailing address

2684 NW 42ND ST
BOCA RATON FL
33434-2566
US

V. Phone/Fax

Practice location:
  • Phone: 561-637-7195
  • Fax:
Mailing address:
  • Phone: 561-994-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: