Provider Demographics
NPI:1295709129
Name:BURTON, JOSEPH EUGENE (LAT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EUGENE
Last Name:BURTON
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6081 COPPERFIELD DR
Mailing Address - Street 2:APT. 125
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2683
Mailing Address - Country:US
Mailing Address - Phone:817-243-8392
Mailing Address - Fax:
Practice Address - Street 1:5700 RAMEY AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-7959
Practice Address - Country:US
Practice Address - Phone:817-496-7400
Practice Address - Fax:817-496-7446
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT12962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer