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NPI Code Detail

MEDICARE: MRS. ROBYN LEE BURT ATC

MEDICARE: MRS. ROBYN LEE BURT ATC
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
12255A2300XAthletic TrainerAT0183MS

General Provider Information

NPI Number : 1689694804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROBYN LEE BURT ATC
Provider Business Mailing Address
First Line : 63 SLEEPY FAWN PARK
Second Line :
City : COLUMBUS
State : MS
Zip : 39702-7829
Country : US
Telephone Number : 662-245-1541
Fax Number :
Provider Business Practice Location Address
First Line : 2623 5TH ST N
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2009
Country : US
Telephone Number : 662-328-3635
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. ROBYN LEE BURT ATC” Practice Location

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