Provider Demographics
NPI:1306036538
Name:RAQUEL, BETTY JANE BURLING (PT)
Entity Type:Individual
Prefix:
First Name:BETTY JANE
Middle Name:BURLING
Last Name:RAQUEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETTY JANE
Other - Middle Name:RAQUEL
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:807 GOLF COURSE PKWY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5533
Mailing Address - Country:US
Mailing Address - Phone:863-206-4743
Mailing Address - Fax:
Practice Address - Street 1:807 GOLF COURSE PKWY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5533
Practice Address - Country:US
Practice Address - Phone:863-206-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist