Provider Demographics
NPI:1154062651
Name:TATE, DAVID BURTON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BURTON
Last Name:TATE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 W 11170 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-2713
Mailing Address - Country:US
Mailing Address - Phone:801-599-2610
Mailing Address - Fax:
Practice Address - Street 1:5800 GRANITE PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6619
Practice Address - Country:US
Practice Address - Phone:972-890-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119898-2401225100000X
TXCP11272T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist