Provider Demographics
NPI:1326335407
Name:BURNS, EILEEN APOSTOL (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:APOSTOL
Last Name:BURNS
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 1:5841 THUNDERBIRD RD STE I
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-4792
Mailing Address - Country:US
Mailing Address - Phone:317-723-6089
Mailing Address - Fax:317-823-0662
Practice Address - Street 1:5841 THUNDERBIRD RD STE I
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-4792
Practice Address - Country:US
Practice Address - Phone:317-723-6089
Practice Address - Fax:317-823-0662
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003853A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400050420OtherMEDICARE PTAN
IN201322380AMedicaid