Provider Demographics
NPI:1013267905
Name:BURTON, SEAN MICHAEL (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MICHAEL
Last Name:BURTON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CARRIAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:STEM
Mailing Address - State:NC
Mailing Address - Zip Code:27581-9123
Mailing Address - Country:US
Mailing Address - Phone:540-257-0523
Mailing Address - Fax:
Practice Address - Street 1:118 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-2341
Practice Address - Country:US
Practice Address - Phone:919-719-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer