Provider Demographics
NPI:1316482755
Name:BURNETT, CORINTHIAS (MPT)
Entity type:Individual
Prefix:MR
First Name:CORINTHIAS
Middle Name:
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7090 ARBOR PKWY APT 1427
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1583
Mailing Address - Country:US
Mailing Address - Phone:870-717-3622
Mailing Address - Fax:
Practice Address - Street 1:7090 ARBOR PKWY APT 1427
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1583
Practice Address - Country:US
Practice Address - Phone:870-717-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0097022251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics