1538866066 NPI number — BURNS PHYSICAL THERAPY AND WELLNESS COMPANY

Table of content: (NPI 1538866066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538866066 NPI number — BURNS PHYSICAL THERAPY AND WELLNESS COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURNS PHYSICAL THERAPY AND WELLNESS COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538866066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13839 AMSTUTZ RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46765-9605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-257-8956
Provider Business Mailing Address Fax Number:
833-579-2878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13839 AMSTUTZ RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46765-9605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-257-8956
Provider Business Practice Location Address Fax Number:
833-579-2878
Provider Enumeration Date:
02/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
JARRED
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official Telephone Number:
260-241-1137

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05013272A . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com