Healthcare Provider Details

I. General information

NPI: 1699563783
Provider Name (Legal Business Name): ELIZABETH BURTON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 MEDICINE LAKE RD
NEW HOPE MN
55427-3404
US

IV. Provider business mailing address

314 CARTWAY CT
CHAMPLIN MN
55316-1331
US

V. Phone/Fax

Practice location:
  • Phone: 763-334-4409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2679
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: