Provider Demographics
NPI:1003000498
Name:BURDINE PHYSICAL THERAPY
Entity type:Organization
Organization Name:BURDINE PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BURDINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:256-534-5946
Mailing Address - Street 1:P.O. BOX 1026
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-2728
Mailing Address - Country:US
Mailing Address - Phone:256-534-5946
Mailing Address - Fax:256-534-3041
Practice Address - Street 1:311 LONGWOOD DR, SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-2728
Practice Address - Country:US
Practice Address - Phone:256-534-5946
Practice Address - Fax:256-534-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2024261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890008010Medicaid
AL51503661OtherBCBS