Healthcare Provider Details

I. General information

NPI: 1568976736
Provider Name (Legal Business Name): LAURIE SUE GUENTHER-BURRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE SUE GUENTHER

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9075 SAN JOSE BLVD
JACKSONVILLE FL
32257-5014
US

IV. Provider business mailing address

PO BOX 1975
ROME GA
30162-1975
US

V. Phone/Fax

Practice location:
  • Phone: 904-661-2916
  • Fax: 866-372-4620
Mailing address:
  • Phone: 706-204-8548
  • Fax: 866-858-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: