MEDICARE: MRS. LESLIE BREWER BURTON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4488	SC

General Provider Information

NPI Number	:	1063668838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE BREWER BURTON PT

Provider Business Mailing Address
First Line	:	1301 RUNNYMEADE LN
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3392
Country	:	US
Telephone Number	:	843-437-9581
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 BAKER HOSPITAL BLVD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8233
Country	:	US
Telephone Number	:	843-744-2750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	08/13/2008

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