Healthcare Provider Details

I. General information

NPI: 1497843890
Provider Name (Legal Business Name): BRIAN THOMAS BURT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 CONNER ST #220
NOBLESVILLE IN
46060-2622
US

IV. Provider business mailing address

5966 CATLIN LN
NOBLESVILLE IN
46062-6504
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-9223
  • Fax: 317-770-9266
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006803A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: