Provider Demographics
NPI:1912246836
Name:BURSON, JOSHUA (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:BURSON
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 1:6168 PIERCE MANSE LOOP
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8577
Mailing Address - Country:US
Mailing Address - Phone:318-780-7879
Mailing Address - Fax:
Practice Address - Street 1:501 JACK STEPHENS DR # 626
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5551
Practice Address - Country:US
Practice Address - Phone:501-526-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2395225200000X
TX2053502225200000X
LAA6771R225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant