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NPI Code Detail

MEDICARE: JACQUELINE BURBANK PT

MEDICARE: JACQUELINE BURBANK PT
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
1225100000XPhysical TherapistPTP-PT-LIC-2198MT
2225100000XPhysical Therapist7959AZ
3225100000XPhysical TherapistPT-2009ID
4225100000XPhysical Therapist329940-2401UT

General Provider Information

NPI Number : 1962417311
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BURBANK PT
Provider Business Mailing Address
First Line : 4428 E CUB RIVER RD
Second Line :
City : PRESTON
State : ID
Zip : 83263-5575
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1020 N 27TH ST
Second Line :
City : BILLINGS
State : MT
Zip : 59101-0760
Country : US
Telephone Number : 406-238-5589
Fax Number : 406-238-5266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 08/17/2016

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Directions to “ JACQUELINE BURBANK PT” Practice Location

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