Healthcare Provider Details

I. General information

NPI: 1851255863
Provider Name (Legal Business Name): WILLIAM WAUGH BURTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BROAD ST STE 113
RICHMOND VA
23284-9058
US

IV. Provider business mailing address

16272 REVA RD
REVA VA
22735-1941
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-0742
  • Fax:
Mailing address:
  • Phone: 540-219-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: