MEDICARE: MRS. JESSICA CRISTINA BURCHETT P.T., DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070018616	IL

General Provider Information

NPI Number	:	1033406335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA CRISTINA BURCHETT P.T., DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE
Second Line	:	STE 104
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-416-9100
Fax Number	:	773-665-9947

Provider Business Practice Location Address
First Line	:	11215 W 159TH ST
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-4416
Country	:	US
Telephone Number	:	773-938-8500
Fax Number	:	773-938-8501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	02/06/2017

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