Provider Demographics
NPI:1730110339
Name:BURTON, ROBERT W (PT OCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:BURTON
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 RT 11 SOUTH
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084
Mailing Address - Country:US
Mailing Address - Phone:315-677-9323
Mailing Address - Fax:315-677-9325
Practice Address - Street 1:2390 RT 11 SOUTH
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084
Practice Address - Country:US
Practice Address - Phone:315-677-9323
Practice Address - Fax:315-677-9325
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0060632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC4387Medicare ID - Type Unspecified
R55583Medicare UPIN