Provider Demographics
NPI:1083121156
Name:BURT, JOSEPH (HAS HIS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BURT
Suffix:
Gender:M
Credentials:HAS HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 POWDER MILL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1233
Mailing Address - Country:US
Mailing Address - Phone:614-620-2733
Mailing Address - Fax:740-654-4327
Practice Address - Street 1:618 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3903
Practice Address - Country:US
Practice Address - Phone:740-654-4327
Practice Address - Fax:740-654-4327
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL02360237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist