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NPI Code Detail

MEDICARE: MR. T. DAVID BURTON JR. LAT, ATC

MEDICARE:  MR. T. DAVID BURTON JR. LAT, ATC
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
12255A2300XAthletic TrainerAT0408TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AT0408OTHERTXLICENSED ATHLETIC TRAINER

General Provider Information

NPI Number : 1568597219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. T. DAVID BURTON JR. LAT, ATC
Provider Business Mailing Address
First Line : 820 CHERLYNNE DR
Second Line : (PO BOX 738 - 75106-0738)
City : CEDAR HILL
State : TX
Zip : 75104-1774
Country : US
Telephone Number : 972-291-2215
Fax Number :
Provider Business Practice Location Address
First Line : 820 CHERLYNNE DR
Second Line :
City : CEDAR HILL
State : TX
Zip : 75104-1774
Country : US
Telephone Number : 972-291-2215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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Directions to “ MR. T. DAVID BURTON JR. LAT, ATC” Practice Location

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