Provider Demographics
NPI:1730678244
Name:BURT, JONATHON (DPT)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:BURT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5381
Mailing Address - Country:US
Mailing Address - Phone:661-547-2224
Mailing Address - Fax:
Practice Address - Street 1:16300 ROSCOE BLVD STE A1
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1246
Practice Address - Country:US
Practice Address - Phone:818-893-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist