Provider Demographics
NPI:1851513568
Name:BURNEY, JEANETTE M (PT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:BURNEY
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:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04576-0539
Mailing Address - Country:US
Mailing Address - Phone:303-591-2739
Mailing Address - Fax:
Practice Address - Street 1:55 PRATTS ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHPORT MAINE
Practice Address - State:ME
Practice Address - Zip Code:04576
Practice Address - Country:US
Practice Address - Phone:303-591-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4157225100000X
ME5858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist