Provider Demographics
NPI:1578591020
Name:BURDETTE, JAY J (PT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:J
Last Name:BURDETTE
Suffix:
Gender:M
Credentials:PT
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Other - Credentials:
Mailing Address - Street 1:105 BEN CASEY DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8561
Mailing Address - Country:US
Mailing Address - Phone:803-802-5855
Mailing Address - Fax:803-802-5869
Practice Address - Street 1:6305 CAROLINA COMMONS DR
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-5987
Practice Address - Country:US
Practice Address - Phone:803-802-5055
Practice Address - Fax:803-802-5052
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-08-08
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Provider Licenses
StateLicense IDTaxonomies
SC5454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250124Medicare PIN