MEDICARE: DR. DAVID BURTON TATE 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	119898-2401	UT
2	225100000X	Physical Therapist	CP11272T	TX

General Provider Information

NPI Number	:	1154062651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BURTON TATE PT, DPT

Provider Business Mailing Address
First Line	:	2529 W 11170 S
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-2713
Country	:	US
Telephone Number	:	801-599-2610
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 GRANITE PKWY STE 1000
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6619
Country	:	US
Telephone Number	:	972-890-9095
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/14/2023

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