Provider Demographics
NPI:1306362439
Name:BURN, TREVAN MITCHELL (PT)
Entity Type:Individual
Prefix:
First Name:TREVAN
Middle Name:MITCHELL
Last Name:BURN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1101
Mailing Address - Country:US
Mailing Address - Phone:815-632-5285
Mailing Address - Fax:815-632-5824
Practice Address - Street 1:1809 LOCUST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1101
Practice Address - Country:US
Practice Address - Phone:815-632-5285
Practice Address - Fax:815-632-5824
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023095208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation