Provider Demographics
NPI:1013981877
Name:BURTON, ALICE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:A
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 1:403 N MILES ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1834
Mailing Address - Country:US
Mailing Address - Phone:270-360-9129
Mailing Address - Fax:270-234-8197
Practice Address - Street 1:632 S LINCOLN BLVD
Practice Address - Street 2:PHYSICAL THERAPY ASSOCIATES
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1051
Practice Address - Country:US
Practice Address - Phone:270-358-9765
Practice Address - Fax:270-358-0104
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000192868OtherANTHEM
KY8700075800Medicaid
KY000000192868OtherANTHEM
S89931Medicare UPIN