Provider Demographics
NPI:1285010710
Name:BURKETT, DANIELLE (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BURKETT
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 1:905 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5390
Mailing Address - Country:US
Mailing Address - Phone:478-333-6363
Mailing Address - Fax:478-333-6076
Practice Address - Street 1:905 ARROWHEAD TRL
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5390
Practice Address - Country:US
Practice Address - Phone:478-333-6363
Practice Address - Fax:478-333-6076
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist