Individual
EVELYNE VANITHA BURTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
1467 N MACK SMITH RD, EAST RIDGE, TN 37412-3947
(423) 894-4403
(423) 894-4513
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3156797
BCBST - GROUP NUMBER
TN
05
—
5441369
—
TN
Enumeration date
05/26/2006
Last updated
02/27/2008
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