Provider Demographics
NPI:1346229457
Name:BURNETT, CAROL A (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:MORTIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:301 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4756
Mailing Address - Country:US
Mailing Address - Phone:724-282-4764
Mailing Address - Fax:724-282-6624
Practice Address - Street 1:301 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4756
Practice Address - Country:US
Practice Address - Phone:724-282-4764
Practice Address - Fax:724-282-6624
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006254L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA515556HBGMedicare ID - Type Unspecified