Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 1307 | AR |
NPI | 1003030842 |
---|---|
Provider Name | Todd Burton |
First Address | Jonesboro, AR 72401-3101 |
Second Address | Jonesboro, AR 72401-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |