Provider Demographics
NPI:1366989402
Name:BURNS, KRISTINE (ATC, PTA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVENUE SUITE 160
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NORTH CAROLINA
Mailing Address - Zip Code:27406
Mailing Address - Country:UM
Mailing Address - Phone:336-545-3546
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVE STE 160
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7613
Practice Address - Country:US
Practice Address - Phone:336-545-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4508225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant