Provider Demographics
NPI:1083853949
Name:BURCH, JENNIFER (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8620 SW 184TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7236
Mailing Address - Country:US
Mailing Address - Phone:305-967-0605
Mailing Address - Fax:
Practice Address - Street 1:8620 SW 184TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7236
Practice Address - Country:US
Practice Address - Phone:305-967-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT178002251P0200X
FLPT 178002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics