Provider Demographics
NPI:1639139728
Name:BURNER, TERRI J (PT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:J
Last Name:BURNER
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 1:208 ADMIRALTY WAY NW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9401
Mailing Address - Country:US
Mailing Address - Phone:478-452-4385
Mailing Address - Fax:
Practice Address - Street 1:SERENITY WELLNESS SPA
Practice Address - Street 2:107 SPORTSMANS CLUB ROAD
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-453-0041
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCWGMedicare ID - Type Unspecified