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General NPI Number Information
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NPI Number | 1457656944
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Entity Type | Individual
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Provider Name | ANNE D BURGESS PTA
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Gender | Female
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 9474 MAYNARD DR
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City | MARCY
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State | NY
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Zip | 13403-2235
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Country | US
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Telephone | 315-266-3420
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Fax | 315-735-3358
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Provider Business Mailing Address
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Address Line | 1 FAIRDALE PL
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City | WHITESBORO
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State | NY
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Zip | 13492-1103
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Country | US
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Telephone | 315-269-7466
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 004502
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License Number State | NY
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