Provider Demographics
NPI:1568597219
Name:BURTON, T. DAVID JR (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:T.
Middle Name:DAVID
Last Name:BURTON
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CHERLYNNE DR
Mailing Address - Street 2:(PO BOX 738 - 75106-0738)
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1774
Mailing Address - Country:US
Mailing Address - Phone:972-291-2215
Mailing Address - Fax:
Practice Address - Street 1:820 CHERLYNNE DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1774
Practice Address - Country:US
Practice Address - Phone:972-291-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT04082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT0408OtherLICENSED ATHLETIC TRAINER