Provider Demographics
NPI:1356984694
Name:BURNETT, CHARLOTTE ADELA (DPT)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ADELA
Last Name:BURNETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:CHARLOTTE
Other - Middle Name:
Other - Last Name:DZUL-GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9136 S SHERIDAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5328
Mailing Address - Country:US
Mailing Address - Phone:918-488-9991
Mailing Address - Fax:918-488-9989
Practice Address - Street 1:7401 RIVERSIDE PKWY UNIT 219
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5057
Practice Address - Country:US
Practice Address - Phone:918-216-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5642OtherOKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION