Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2683 | SC |
NPI | 1003186461 |
---|---|
Provider Name | Mrs. Donna Lynn Burchell |
First Address | Goldsboro, NC 27530-9228 |
Second Address | Myrtle Beach, SC 29579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2012 |
Last Update Date | 03/01/2012 |