Provider Demographics
NPI:1134796105
Name:BURNS, JOHNATHON DRAKE (PT)
Entity type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:DRAKE
Last Name:BURNS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 UTICA SQ STE 1B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1452
Mailing Address - Country:US
Mailing Address - Phone:918-720-5989
Mailing Address - Fax:
Practice Address - Street 1:1876 UTICA SQ STE 1B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1452
Practice Address - Country:US
Practice Address - Phone:918-720-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist