Provider Demographics
NPI:1386217412
Name:BURNELL, LATOYA (SABRINA) SABRINA (PTA19697)
Entity Type:Individual
Prefix:
First Name:LATOYA (SABRINA)
Middle Name:SABRINA
Last Name:BURNELL
Suffix:
Gender:F
Credentials:PTA19697
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33740 SKIFF ALY UNIT 305
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5484
Mailing Address - Country:US
Mailing Address - Phone:561-351-3417
Mailing Address - Fax:
Practice Address - Street 1:2600 COMPASS RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8001
Practice Address - Country:US
Practice Address - Phone:877-787-3422
Practice Address - Fax:847-441-4130
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0011528225200000X
FLPTA19697225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant