MEDICARE: WILLIAM E. BURNS JR. P.T.

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	020054-1	NY

General Provider Information

NPI Number	:	1508872250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM E. BURNS JR. P.T.

Provider Business Mailing Address
First Line	:	433 FORT SALONGA RD
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-3048
Country	:	US
Telephone Number	:	631-651-8644
Fax Number	:	631-651-8645

Provider Business Practice Location Address
First Line	:	433 FORT SALONGA RD
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-3048
Country	:	US
Telephone Number	:	631-651-8644
Fax Number	:	631-651-8645

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	12/07/2007

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