Individual
MINDY GAYLE BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 RIVER RUN, SUITE 104, FORT WORTH, TX 76107-6579
(817) 882-9611
(817) 882-9976
Mailing address
PO BOX 1199, AZLE, TX 76098-1199
(817) 676-2126
(817) 237-3960
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2032316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2032316
ECPTOTE OF TEXAS
TX
Enumeration date
07/19/2007
Last updated
07/19/2007
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