Provider Demographics
NPI:1982447322
Name:BASTES BURNS, JINKY
Entity type:Individual
Prefix:
First Name:JINKY
Middle Name:
Last Name:BASTES BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16282 ALCIRA CIR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33955-4129
Mailing Address - Country:US
Mailing Address - Phone:630-453-1719
Mailing Address - Fax:
Practice Address - Street 1:16282 ALCIRA CIR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33955-4129
Practice Address - Country:US
Practice Address - Phone:630-453-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist