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General NPI Number Information
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NPI Number | 1063145324
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Entity Type | Individual
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Provider Name | JENNIFER MICHELE BURKETT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 9037 INDEPENDENCE AVE STE A2
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City | DAPHNE
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State | AL
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Zip | 36526-7694
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Country | US
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Telephone | 251-459-0500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 152
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City | IRVINGTON
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State | AL
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Zip | 36544-0152
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Country | US
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Telephone | 662-200-6182
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 5862
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License Number State | AL
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