Provider Demographics
NPI:1538464045
Name:BURDORF, KELLIANNE (ATC)
Entity Type:Individual
Prefix:
First Name:KELLIANNE
Middle Name:
Last Name:BURDORF
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 MOUNTAIN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 MOUNTAIN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:CANE RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37013-5699
Practice Address - Country:US
Practice Address - Phone:756-983-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer