Provider Demographics
NPI:1053371781
Name:BURTH, SHEILA M (PT)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:BURTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:231 WALTON SREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1230
Mailing Address - Country:US
Mailing Address - Phone:315-478-0380
Mailing Address - Fax:315-478-0388
Practice Address - Street 1:419 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1925
Practice Address - Country:US
Practice Address - Phone:315-717-0278
Practice Address - Fax:315-717-0280
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3091Medicare PIN
NYCC5384Medicare ID - Type UnspecifiedMEDICARE NUMBER
NYP30079Medicare UPIN