MEDICARE: MARCUS T BURTON PT, 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	9439625-2401	UT

General Provider Information

NPI Number	:	1114396702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS T BURTON PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 103
Second Line	:
City	:	CALIENTE
State	:	NV
Zip	:	89008-0103
Country	:	US
Telephone Number	:	775-726-3117
Fax Number	:	775-726-3118

Provider Business Practice Location Address
First Line	:	660 E MAIN ST SUITE B
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725-0549
Country	:	US
Telephone Number	:	775-726-3117
Fax Number	:	775-726-3118

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	09/24/2015

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