Staci A Burris
Physical Therapy Assistant
900 Centennial Dr # 30
East Peoria
, Illinois 61611-4928
Staci A Burris
Physical Therapy Assistant
900 Centennial Dr # 30
East Peoria
, Illinois 61611-4928
(309) 251-9707
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About
Features
Specialties
- Physical Therapy Assistant
Languages spoken
- English
Location
First Address
- Staci A Burris
- 1141 N Nancy St
- East Peoria, IL
- Zip : 61611-9554
- Phone : (309) 251-9707
Second Address
- Staci A Burris
- 900 Centennial Dr # 30
- East Peoria, IL
- Zip : 61611-4928
- Phone : (309) 699-5400
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225200000X | Physical Therapy Assistant | 160005049 | IL |
National Provider Identifier
| NPI | 1003428806 |
|---|---|
| Provider Name | Staci A Burris |
| First Address | East Peoria, IL 61611-9554 |
| Second Address | East Peoria, IL 61611-4928 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 21/08/2020 |
| Last Update Date | 21/08/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.