Healthcare Provider Details

I. General information

NPI: 1174413223
Provider Name (Legal Business Name): PATRICIA BURSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 S FAIR OAKS AVE STE 110
PASADENA CA
91105-2614
US

IV. Provider business mailing address

6909 E ESPANITA ST
LONG BEACH CA
90815-4820
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7620
  • Fax: 818-369-7621
Mailing address:
  • Phone: 562-522-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: