=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265222426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAROD BURDS DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2025
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3156 NORTHSIDE DR
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-8024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-292-1805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | W7439 SYLVESTER RD
-----------------------------------------------------
City | HOLMEN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54636-9232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | CP044358T
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT44164
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 16827-24
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------