Healthcare Provider Details

I. General information

NPI: 1871543827
Provider Name (Legal Business Name): SHAUNA MARIE BURNS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SHAUNA MARIE BOILEK PT

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 AIRPORT RD
PORTAGE IN
46368-5105
US

IV. Provider business mailing address

824 175TH ST
HAMMOND IN
46324-2722
US

V. Phone/Fax

Practice location:
  • Phone: 219-762-0821
  • Fax: 219-763-3637
Mailing address:
  • Phone: 219-937-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007311A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: