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General NPI Number Information
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NPI Number | 1356609309
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Entity Type | Individual
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Provider Name | DUSTIN CHRISTOPHER BURTON ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 2360 MULLAN RD STE C
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City | MISSOULA
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State | MT
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Zip | 59808-1811
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Country | US
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Telephone | 406-721-4436
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Fax |
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Provider Business Mailing Address
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Address Line | 1744 S 14TH ST W
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City | MISSOULA
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State | MT
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Zip | 59801-4924
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Country | US
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Telephone | 406-239-8971
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 144
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License Number State | MT
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