Provider Demographics
NPI:1518992460
Name:BURNS, SANDRA M (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:BURNS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1089
Mailing Address - Country:US
Mailing Address - Phone:815-834-2400
Mailing Address - Fax:815-834-2424
Practice Address - Street 1:9634 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3391
Practice Address - Country:US
Practice Address - Phone:708-423-4800
Practice Address - Fax:708-423-4843
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623066OtherBCBS PROVIDER NUMBER
IL1623066OtherBCBS PROVIDER NUMBER
IL202542Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL567770Medicare ID - Type UnspecifiedMEDICARE GROUP
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER