Healthcare Provider Details

I. General information

NPI: 1285233007
Provider Name (Legal Business Name): JENNIFER RENEE BURNS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 SE 3RD ST
NEWTON KS
67114-3904
US

IV. Provider business mailing address

216 PINE ST
HALSTEAD KS
67056-1920
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-6600
  • Fax:
Mailing address:
  • Phone: 316-772-3586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN040004
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-03764
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: