Provider Demographics
NPI:1114209160
Name:BURNS, STEPHANIE NICHOLE (DPT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICHOLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD.
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-372-7060
Mailing Address - Fax:781-372-7069
Practice Address - Street 1:16 HAYDEN AVE
Practice Address - Street 2:LAHEY LEXINGTON
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7929
Practice Address - Country:US
Practice Address - Phone:781-372-7060
Practice Address - Fax:781-372-7069
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38111225100000X
MA20036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093924AMedicaid
MA002902301Medicare PIN