Provider Demographics
NPI:1710281845
Name:PHILLIPS-BURDGE, ELEANORA ANGELA
Entity type:Individual
Prefix:
First Name:ELEANORA
Middle Name:ANGELA
Last Name:PHILLIPS-BURDGE
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 1:116 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9752
Mailing Address - Country:US
Mailing Address - Phone:607-708-1110
Mailing Address - Fax:607-708-1130
Practice Address - Street 1:116 WOOD RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9752
Practice Address - Country:US
Practice Address - Phone:607-708-1110
Practice Address - Fax:607-708-1130
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist