Provider Demographics
NPI:1164795043
Name:BURNETT, JANICE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:LYNN
Last Name:BURNETT
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 1:4110 TIVOLI CT
Mailing Address - Street 2:#106
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4097
Mailing Address - Country:US
Mailing Address - Phone:561-414-8684
Mailing Address - Fax:
Practice Address - Street 1:4110 TIVOLI CT
Practice Address - Street 2:#106
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-4097
Practice Address - Country:US
Practice Address - Phone:561-414-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23169225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant