Provider Demographics
NPI:1265476303
Name:BURTON, BUFFY BENNETTA (PT)
Entity Type:Individual
Prefix:
First Name:BUFFY
Middle Name:BENNETTA
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 1:2114 MONTREAT WAY
Mailing Address - Street 2:A
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4041
Mailing Address - Country:US
Mailing Address - Phone:205-305-8440
Mailing Address - Fax:
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-802-6992
Practice Address - Fax:205-802-6916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ13071Medicare UPIN