Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CB122837 | PA |
NPI | 1346539061 |
---|---|
Provider Name | Mrs. Capri N. Burt |
First Address | Philadelphia, PA 19120 |
Second Address | Philadelphia, PA 19120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 04/04/2011 |