Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | PT 17800 | FL |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT17800 | FL |
NPI | 1083853949 |
---|---|
Provider Name | Jennifer Burch |
First Address | Cutler Bay, FL 33157-7236 |
Second Address | Cutler Bay, FL 33157-7236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2009 |
Last Update Date | 09/03/2015 |