Provider Demographics
NPI:1629075965
Name:BURDINE, DOROTHY I (PT)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:I
Last Name:BURDINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:I
Other - Last Name:BURDINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-0026
Mailing Address - Country:US
Mailing Address - Phone:256-534-5946
Mailing Address - Fax:256-534-3041
Practice Address - Street 1:311 LONGWOOD DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5210
Practice Address - Country:US
Practice Address - Phone:256-534-5946
Practice Address - Fax:256-534-3041
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550788BURMedicare ID - Type UnspecifiedPROVIDER NUMBER
AL51503661Medicare UPIN