Provider Demographics
NPI:1154948933
Name:MY PT AND PILATES INC
Entity type:Organization
Organization Name:MY PT AND PILATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BURGETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-224-5058
Mailing Address - Street 1:6706 RED JACKET RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2633
Mailing Address - Country:US
Mailing Address - Phone:903-224-5058
Mailing Address - Fax:
Practice Address - Street 1:6706 RED JACKET RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2633
Practice Address - Country:US
Practice Address - Phone:903-224-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy