MEDICARE: CHASE BURTON DPT

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	1253813	TX

General Provider Information

NPI Number	:	1093106890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE BURTON DPT

Provider Business Mailing Address
First Line	:	4120 HERITAGE TRACE PKWY
Second Line	:	SUITE 220
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 HERITAGE TRACE PKWY
Second Line	:	SUITE 220
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5308
Country	:	US
Telephone Number	:	817-741-7585
Fax Number	:

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	02/16/2015

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Directions to “ CHASE BURTON DPT” Practice Location

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