Provider Demographics
NPI:1598134413
Name:BURTON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BURTON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:870-243-9033
Mailing Address - Street 1:3424 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9502
Mailing Address - Country:US
Mailing Address - Phone:870-243-9033
Mailing Address - Fax:
Practice Address - Street 1:3424 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9502
Practice Address - Country:US
Practice Address - Phone:870-243-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR209015742Medicaid