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General NPI Number Information
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NPI Number | 1306156559
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Entity Type | Individual
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Provider Name | NATHAN BURNETT PTA
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Gender | Male
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 4650 HOEN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-9407
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Country | US
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Telephone | 512-387-9213
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 GLEN
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City | SPRINGDALE
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State | AR
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Zip | 72762
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA2465
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 9724
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License Number State | CA
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