Provider Demographics
NPI:1255472262
Name:BURTON, MEQUEL RENE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEQUEL
Middle Name:RENE
Last Name:BURTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 COUNTY ROAD 1123
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65259-2302
Mailing Address - Country:US
Mailing Address - Phone:660-277-3771
Mailing Address - Fax:660-277-4782
Practice Address - Street 1:1008 COUNTY ROAD 1123
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65259-2302
Practice Address - Country:US
Practice Address - Phone:660-277-3771
Practice Address - Fax:660-277-4782
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist