Provider Demographics
NPI:1679618789
Name:BURNETT, JOHN GERALD (MS,ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GERALD
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SOUTH REBECCA ST.
Mailing Address - Street 2:
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056
Mailing Address - Country:US
Mailing Address - Phone:724-352-4748
Mailing Address - Fax:
Practice Address - Street 1:1446 KITTANNING PIKE
Practice Address - Street 2:
Practice Address - City:KARNS CITY
Practice Address - State:PA
Practice Address - Zip Code:16041
Practice Address - Country:US
Practice Address - Phone:724-756-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0011787A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer