Provider Demographics
NPI:1205930716
Name:BURBRIDGE, JANET LEIGH (PT, MS)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LEIGH
Last Name:BURBRIDGE
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:999 44TH ST
Mailing Address - Street 2:SUITE 10,000
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3846
Mailing Address - Country:US
Mailing Address - Phone:319-373-7311
Mailing Address - Fax:319-373-7313
Practice Address - Street 1:999 44TH ST
Practice Address - Street 2:SUITE 10,000
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3846
Practice Address - Country:US
Practice Address - Phone:319-373-7311
Practice Address - Fax:319-373-7313
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0209510Medicaid
IA17428OtherBLUE CROSS/BLUE SHIELD
17428Medicare PIN