Provider Demographics
NPI:1629564273
Name:BURNHAM, LYNNORE FRANCES PANTALEON
Entity Type:Individual
Prefix:MISS
First Name:LYNNORE FRANCES
Middle Name:PANTALEON
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:
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 60348
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-7348
Mailing Address - Country:US
Mailing Address - Phone:785-550-3782
Mailing Address - Fax:
Practice Address - Street 1:91-1384 HALILI ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6538
Practice Address - Country:US
Practice Address - Phone:785-550-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPTA-401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant