Provider Demographics
NPI:1891743340
Name:BURTON, TYSON JAMES (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:TYSON
Middle Name:JAMES
Last Name:BURTON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4520
Mailing Address - Country:US
Mailing Address - Phone:757-784-8180
Mailing Address - Fax:757-221-3412
Practice Address - Street 1:1 CAMPUS DRIVE
Practice Address - Street 2:WILLIAMS & MARY HALL
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23187
Practice Address - Country:US
Practice Address - Phone:757-221-3406
Practice Address - Fax:757-221-3412
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer