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General NPI Number Information
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NPI Number | 1568265189
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Entity Type | Individual
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Provider Name | WILLIAM TROY BURGESS
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Gender | Male
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 101 W WINDSOR RD
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City | URBANA
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State | IL
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Zip | 61802-6603
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Country | US
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Telephone | 217-344-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 DOUGLAS ST APT 2
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City | CHARLESTON
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State | IL
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Zip | 61920-4519
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Country | US
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Telephone | 217-218-1763
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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 | 160.006193
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License Number State | IL
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