Individual
MARY BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
512 S JADE LANE, ROUND LAKE, IL 60073
(262) 960-5445
Mailing address
512 S JADE LN, ROUND LAKE, IL 60073-8163
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
07/28/2017
Last updated
07/28/2017
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