Provider Demographics
NPI:1659321891
Name:BURTON, ANGELA GAIL (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:GAIL
Last Name:BURTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 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:870-243-3889
Mailing Address - Fax:870-275-7706
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:870-243-3889
Practice Address - Fax:870-275-7706
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 1998225200000X
ARPT 2959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154145721Medicaid