Provider Demographics
NPI:1003845579
Name:BURCH, JEANIE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:JEANIE
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2222
Mailing Address - Country:US
Mailing Address - Phone:662-453-5681
Mailing Address - Fax:
Practice Address - Street 1:1802 STRONG AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-3910
Practice Address - Country:US
Practice Address - Phone:662-392-5599
Practice Address - Fax:662-459-7139
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT02332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer