Provider Demographics
NPI:1235254061
Name:BURKETT, SUSAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LEONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:463 ASHLEY RIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7231
Mailing Address - Country:US
Mailing Address - Phone:318-671-8772
Mailing Address - Fax:318-671-8776
Practice Address - Street 1:463 ASHLEY RIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7231
Practice Address - Country:US
Practice Address - Phone:318-671-8772
Practice Address - Fax:318-671-8776
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA06444OtherSTATE LICENSE