Provider Demographics
NPI:1184150286
Name:BURGESS, WILLIAM 'ADAM' (PTA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:'ADAM'
Last Name:BURGESS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-4024
Mailing Address - Country:US
Mailing Address - Phone:865-518-3647
Mailing Address - Fax:
Practice Address - Street 1:1204 FRYE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3052
Practice Address - Country:US
Practice Address - Phone:423-745-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4908225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant