Provider Demographics
NPI:1891924601
Name:BURRELL, JUSTINE DANIELLE (PT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:DANIELLE
Last Name:BURRELL
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 1:441 MARION ST
Mailing Address - Street 2:
Mailing Address - City:BROWNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1228
Mailing Address - Country:US
Mailing Address - Phone:570-960-1782
Mailing Address - Fax:
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1418
Practice Address - Country:US
Practice Address - Phone:570-785-2018
Practice Address - Fax:570-785-2061
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093275Medicare PIN