Provider Demographics
NPI:1487658886
Name:DEWEESE, BURT (PT)
Entity Type:Individual
Prefix:MR
First Name:BURT
Middle Name:
Last Name:DEWEESE
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 1:7443 SW CANNOCK CHASE RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4780
Mailing Address - Country:US
Mailing Address - Phone:785-478-1824
Mailing Address - Fax:785-271-8818
Practice Address - Street 1:5220 SW 17TH
Practice Address - Street 2:SUITE 130
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2459
Practice Address - Country:US
Practice Address - Phone:785-271-5533
Practice Address - Fax:785-271-8818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11-03443225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
140790OtherBLUE CROSS
140790Medicare ID - Type Unspecified