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NPI Code Detail

MEDICARE: MISS KELSEY DANIELLE BURNS PTA

MEDICARE: MISS KELSEY DANIELLE BURNS PTA
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
1225200000XPhysical Therapy Assistant2101329TX
2225200000XPhysical Therapy AssistantPTA3804AR

General Provider Information

NPI Number : 1053716571
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KELSEY DANIELLE BURNS PTA
Provider Business Mailing Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 903-793-6135
Fax Number : 903-793-0053
Provider Business Practice Location Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 903-793-6135
Fax Number : 903-793-0053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2014
Last Update Date : 10/27/2014

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Directions to “ MISS KELSEY DANIELLE BURNS PTA” Practice Location

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