Provider Demographics
NPI:1033406335
Name:BURCHETT, JESSICA CRISTINA (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CRISTINA
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:CRISTINA
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:773-665-9947
Practice Address - Street 1:11215 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4416
Practice Address - Country:US
Practice Address - Phone:773-938-8500
Practice Address - Fax:773-938-8501
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist