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NPI Code Detail

MEDICARE: JANICE LYNN BURNETT PTA

MEDICARE:   JANICE LYNN BURNETT  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 AssistantPTA23169FL

General Provider Information

NPI Number : 1164795043
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE LYNN BURNETT PTA
Provider Business Mailing Address
First Line : 4110 TIVOLI CT
Second Line : #106
City : LAKE WORTH
State : FL
Zip : 33467-4097
Country : US
Telephone Number : 561-414-8684
Fax Number :
Provider Business Practice Location Address
First Line : 4110 TIVOLI CT
Second Line : #106
City : LAKE WORTH
State : FL
Zip : 33467-4097
Country : US
Telephone Number : 561-414-8684
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2012
Last Update Date : 02/22/2012

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Directions to “ JANICE LYNN BURNETT PTA” Practice Location

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