MEDICARE: MARROW BURNETTE PT, MSPT, OCS, COMT

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	19660	FL

General Provider Information

NPI Number	:	1346380649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARROW BURNETTE PT, MSPT, OCS, COMT

Provider Business Mailing Address
First Line	:	3141 BRACHENBURY LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-3716
Country	:	US
Telephone Number	:	904-403-3880
Fax Number	:	904-337-1093

Provider Business Practice Location Address
First Line	:	4745 SUTTON PARK CT
Second Line	:	SUITE 803
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0250
Country	:	US
Telephone Number	:	904-403-3880
Fax Number	:	904-337-1093

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	11/05/2012

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