Provider Demographics
NPI:1063449262
Name:BURNS, SANDRA (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 FUTURES DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3917
Mailing Address - Country:US
Mailing Address - Phone:402-412-4271
Mailing Address - Fax:402-412-4296
Practice Address - Street 1:2800 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3755
Practice Address - Country:US
Practice Address - Phone:712-279-3178
Practice Address - Fax:712-279-3467
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist