Provider Demographics
NPI:1346576972
Name:BURNS, KATHLEEN ELIZABETH (MSPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:BURNS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 SWEETWATER CV # 2107
Mailing Address - Street 2:#2107
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4185
Mailing Address - Country:US
Mailing Address - Phone:617-877-1499
Mailing Address - Fax:
Practice Address - Street 1:1285 SWEETWATER CV # 2107
Practice Address - Street 2:#2107
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-4185
Practice Address - Country:US
Practice Address - Phone:617-877-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21314225100000X
MA16245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist