Provider Demographics
NPI:1376517912
Name:BURNS, WILLIAM E JR (DPT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 HEATHER GLEN LN
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1172
Mailing Address - Country:US
Mailing Address - Phone:860-536-0418
Mailing Address - Fax:
Practice Address - Street 1:55 BEACH ST
Practice Address - Street 2:SUITES 1 & 2
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2770
Practice Address - Country:US
Practice Address - Phone:401-348-1010
Practice Address - Fax:401-348-9550
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007640174400000X
RIPT01857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT08000764CT01OtherBCBS PROVIDER ID
CT650001132Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID