Basic Information
| Provider Information | |||||||||
| NPI: | 1386189298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURR | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2978 HUNTINGTON TRAIL DR | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381153437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014912205 | ||||||||
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| Practice Location | |||||||||
| Address1: | 317 W SPRING ST | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385017102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315269518 | ||||||||
| FaxNumber: | 9313720087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2016 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 5584 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.