Provider Demographics
NPI:1457656944
Name:BURGESS, ANNE D (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FAIRDALE PL
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1103
Mailing Address - Country:US
Mailing Address - Phone:315-269-7466
Mailing Address - Fax:
Practice Address - Street 1:9474 MAYNARD DR
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403-2235
Practice Address - Country:US
Practice Address - Phone:315-266-3420
Practice Address - Fax:315-735-3358
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant