=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518665991
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN BURNS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2023
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 SW REGENCY PKWY STE 5
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-7488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-252-3321
-----------------------------------------------------
Fax | 479-668-2257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 SW REGENCY PKWY STE 5
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-7488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-252-3321
-----------------------------------------------------
Fax | 479-668-2257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT5265
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------