Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2005000217 | MO |
NPI | 1003014150 |
---|---|
Provider Name | Brittany Marie Burchett |
First Address | Saint Louis, MO 63129-3314 |
Second Address | Saint Louis, MO 63110-4048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/07/2007 |