Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT017606 | PA |
N | 2251C2600X | Cardiopulmonary | 2029 | WV |
NPI | 1417072463 |
---|---|
Provider Name | Ramona Lue Burnett |
First Address | Fairmont, WV 26554-7804 |
Second Address | Fairmont, WV 26554-2179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |