Healthcare Provider Details

I. General information

NPI: 1609437847
Provider Name (Legal Business Name): DAWN MARIE BURDETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 KING ARTHUR CT
SAINT AUGUSTINE FL
32086-8897
US

IV. Provider business mailing address

153 KING ARTHUR CT
SAINT AUGUSTINE FL
32086-8897
US

V. Phone/Fax

Practice location:
  • Phone: 904-501-6702
  • Fax:
Mailing address:
  • Phone: 904-501-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA24234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: