MEDICARE: NOAH BURTON

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	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2052430	OTHER	TX	LICENSE #

General Provider Information

NPI Number	:	1265542914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH BURTON

Provider Business Mailing Address
First Line	:	3809 SUMMERSVILLE LN
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-1756
Country	:	US
Telephone Number	:	817-898-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 BASSWOOD BLVD
Second Line	:	STE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4476
Country	:	US
Telephone Number	:	817-498-0700
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ NOAH BURTON ” Practice Location

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