Individual
MARY BURNHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
808 MILL LAKE RD, FORT WAYNE, IN 46845-6400
(260) 338-1241
(260) 338-1231
Mailing address
22222 MONROEVILLE ROAD, MONROEVILLE, IN 46773
(260) 338-1241
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05006468A
IN
Other
Enumeration date
05/04/2007
Last updated
07/09/2007
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