Provider Demographics
NPI:1265269062
Name:BURTON, MARY-KATHERINE WATT (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY-KATHERINE
Middle Name:WATT
Last Name:BURTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 INDEPENDENCE PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1506
Mailing Address - Country:US
Mailing Address - Phone:404-952-0613
Mailing Address - Fax:
Practice Address - Street 1:4900 IVEY RD NW STE 1720
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4101
Practice Address - Country:US
Practice Address - Phone:770-917-5737
Practice Address - Fax:770-917-5740
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0174152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics