MEDICARE: MR. KENNETH W BURNS PT, CSCS

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	2251X0800X	Orthopedic Physical Therapist	PT18609	CA

General Provider Information

NPI Number	:	1477524221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH W BURNS PT, CSCS

Provider Business Mailing Address
First Line	:	1200 INDUSTRIAL RD
Second Line	:	SUITE 1
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-4123
Country	:	US
Telephone Number	:	650-654-1223
Fax Number	:	650-654-1205

Provider Business Practice Location Address
First Line	:	1200 INDUSTRIAL RD
Second Line	:	SUITE 1
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-4123
Country	:	US
Telephone Number	:	650-654-1223
Fax Number	:	650-654-1205

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/13/2013

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