Provider Demographics
NPI:1174203400
Name:BURCHETT, ISABELLA QUINTERO (DPT)
Entity type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:QUINTERO
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BEACH BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5482
Mailing Address - Country:US
Mailing Address - Phone:904-774-2744
Mailing Address - Fax:
Practice Address - Street 1:408 BEACH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5482
Practice Address - Country:US
Practice Address - Phone:904-774-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist