Provider Demographics
NPI:1326364142
Name:BURNS, JILLIAN MARY (DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARY
Last Name:BURNS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4428
Mailing Address - Country:US
Mailing Address - Phone:770-813-5575
Mailing Address - Fax:770-813-0032
Practice Address - Street 1:10090 MEDLOCK BRIDGE RD
Practice Address - Street 2:STE 100
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4428
Practice Address - Country:US
Practice Address - Phone:770-813-5575
Practice Address - Fax:770-813-0032
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT9787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist