Provider Demographics
NPI:1457329401
Name:BURTON, MICHELLE ANN (MPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:BURTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-0914
Mailing Address - Country:US
Mailing Address - Phone:435-259-1114
Mailing Address - Fax:435-259-1133
Practice Address - Street 1:1105 S HIGHWAY 191 STE 1
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-3011
Practice Address - Country:US
Practice Address - Phone:435-259-1114
Practice Address - Fax:435-259-1133
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7655429-24012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101866Medicare ID - Type Unspecified