Provider Demographics
NPI:1336306794
Name:BURNETT, JULIE (PT, MS)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1306
Mailing Address - Country:US
Mailing Address - Phone:801-532-3539
Mailing Address - Fax:801-328-3926
Practice Address - Street 1:41 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1306
Practice Address - Country:US
Practice Address - Phone:801-532-3539
Practice Address - Fax:801-328-3926
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT117149-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist