Provider Demographics
NPI:1346380649
Name:BURNETTE, MARROW (PT, MSPT, OCS, COMT)
Entity Type:Individual
Prefix:
First Name:MARROW
Middle Name:
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:PT, MSPT, OCS, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 BRACHENBURY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3716
Mailing Address - Country:US
Mailing Address - Phone:904-403-3880
Mailing Address - Fax:904-337-1093
Practice Address - Street 1:4745 SUTTON PARK CT
Practice Address - Street 2:SUITE 803
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0250
Practice Address - Country:US
Practice Address - Phone:904-403-3880
Practice Address - Fax:904-337-1093
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist