Healthcare Provider Details

I. General information

NPI: 1740900398
Provider Name (Legal Business Name): ANNA MAE BURMESTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA SCHOTT

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STATE ST
CHESTER IL
62233-1116
US

IV. Provider business mailing address

9424 LL RD
RED BUD IL
62278-3306
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4581
  • Fax:
Mailing address:
  • Phone: 618-317-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160006562
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: