Healthcare Provider Details

I. General information

NPI: 1083812499
Provider Name (Legal Business Name): AMY BURTNER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 MORTHLAND DR STE A
VALPARAISO IN
46383-6205
US

IV. Provider business mailing address

159 E 700 S
KOUTS IN
46347-9673
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-5850
  • Fax:
Mailing address:
  • Phone: 219-405-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06001244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: