Provider Demographics
NPI:1770112336
Name:BURNETTE, BROOKLYNNE ASHLIE
Entity type:Individual
Prefix:
First Name:BROOKLYNNE
Middle Name:ASHLIE
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3347
Mailing Address - Country:US
Mailing Address - Phone:804-720-7405
Mailing Address - Fax:
Practice Address - Street 1:4355 PHEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5272
Practice Address - Country:US
Practice Address - Phone:540-725-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist