Healthcare Provider Details

I. General information

NPI: 1194369579
Provider Name (Legal Business Name): LORI ELDER BURNETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W MAIN ST
LIVINGSTON TN
38570-1718
US

IV. Provider business mailing address

1660 GOLF LN
LIVINGSTON TN
38570-2111
US

V. Phone/Fax

Practice location:
  • Phone: 800-844-8515
  • Fax: 866-460-8525
Mailing address:
  • Phone: 931-265-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1724
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: