Provider Demographics
NPI:1700562691
Name:BURNETT, CARLY PAYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:PAYNE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:JORDAN
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:634 CLIFFSIDE RD.
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367
Mailing Address - Country:US
Mailing Address - Phone:423-447-2270
Mailing Address - Fax:
Practice Address - Street 1:17919 RANKIN AVENUE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327
Practice Address - Country:US
Practice Address - Phone:423-949-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist