Provider Demographics
NPI:1194369579
Name:BURNETT, LORI ELDER (PT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELDER
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 GOLF LN
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-2111
Mailing Address - Country:US
Mailing Address - Phone:931-265-3167
Mailing Address - Fax:
Practice Address - Street 1:508 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1718
Practice Address - Country:US
Practice Address - Phone:800-844-8515
Practice Address - Fax:866-460-8525
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist