Provider Demographics
NPI:1376754531
Name:BURNETT, ADRIENNE LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LEIGH
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:17053 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2059
Mailing Address - Country:US
Mailing Address - Phone:954-558-1482
Mailing Address - Fax:
Practice Address - Street 1:17053 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2059
Practice Address - Country:US
Practice Address - Phone:954-558-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20695225200000X
TX2050725225200000X
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant