Basic Information
| Provider Information | |||||||||
| NPI: | 1326364142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10090 MEDLOCK BRIDGE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300974428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708135575 | ||||||||
| FaxNumber: | 7708130032 | ||||||||
| Practice Location | |||||||||
| Address1: | 10090 MEDLOCK BRIDGE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300974428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708135575 | ||||||||
| FaxNumber: | 7708130032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 04/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT9787 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.