Provider Demographics
NPI:1427129758
Name:BURGESS, JODI ANNE (MSPT)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:ANNE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BARKER RD
Mailing Address - Street 2:
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-1286
Mailing Address - Country:US
Mailing Address - Phone:508-295-3399
Mailing Address - Fax:
Practice Address - Street 1:3119 CRANBERRY HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4840
Practice Address - Country:US
Practice Address - Phone:508-759-5411
Practice Address - Fax:508-759-6194
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist