Provider Demographics
NPI:1033297296
Name:BURTIN, GREGORY ALAN (PT, MPT, CERT MDT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:BURTIN
Suffix:
Gender:M
Credentials:PT, MPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 REMINGTON CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-3935
Mailing Address - Country:US
Mailing Address - Phone:979-587-1002
Mailing Address - Fax:979-690-2510
Practice Address - Street 1:1305 REMINGTON CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-3935
Practice Address - Country:US
Practice Address - Phone:979-587-1002
Practice Address - Fax:979-690-2510
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist