Provider Demographics
NPI:1578851283
Name:BURGESS, TODD ALLEN (LPTA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLEN
Last Name:BURGESS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17421 RIMROCK DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2564
Mailing Address - Country:US
Mailing Address - Phone:303-216-2283
Mailing Address - Fax:
Practice Address - Street 1:17421 RIMROCK DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2564
Practice Address - Country:US
Practice Address - Phone:303-216-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8012655-2402225200000X
CONA-152991376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No376K00000XNursing Service Related ProvidersNurse's Aide