Provider Demographics
NPI:1093857435
Name:BURCH, MARIE LINDA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LINDA
Last Name:BURCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 WINDSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8049
Mailing Address - Country:US
Mailing Address - Phone:561-795-1698
Mailing Address - Fax:561-798-1122
Practice Address - Street 1:1526 WINDSHIP CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8049
Practice Address - Country:US
Practice Address - Phone:561-795-1698
Practice Address - Fax:561-798-1122
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1802225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant