Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT015862 | PA |
NPI | 1043334303 |
---|---|
Provider Name | Mr. Jamiylah Sika Burns |
First Address | Philadelphia, PA 19124-2343 |
Second Address | Philadelphia, PA 19124-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |