Provider Demographics
NPI:1093048142
Name:BURNS, JAMES R (DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-5757
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:103 MEDICAL PARK FL 1
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-9042
Practice Address - Country:US
Practice Address - Phone:601-268-5757
Practice Address - Fax:601-579-5220
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1033218524OtherGROUP NPI
MS09015077Medicaid
MS09015077Medicaid
MS381353YNB2Medicare Oscar/Certification