1982786166 NPI number — STEPHANIE M BURNETT LPT

Table of content: STEPHANIE M BURNETT LPT (NPI 1982786166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982786166 NPI number — STEPHANIE M BURNETT LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNETT
Provider First Name:
STEPHANIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANDEL
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982786166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6545 SPENCER CLARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOWLER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44418-9761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-772-0351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 W LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUBBARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44425-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-534-8500
Provider Business Practice Location Address Fax Number:
330-534-3926
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT09681 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT020704 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000216468 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 172775 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2344261 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34188311028 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6497047 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34177311027 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34187731100 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000218075 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34187731101 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 214507 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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