MEDICARE: MR. ROBERT MICHAEL BURTON A.T.C., L.A.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	2255A2300X	Athletic Trainer	AL 360	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22	OTHER	FL	ATHLETIC TRAINER

General Provider Information

NPI Number	:	1790908093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MICHAEL BURTON A.T.C., L.A.T.

Provider Business Mailing Address
First Line	:	2933 SW BRIGHTON WAY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-6085
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 SW BRIGHTON WAY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-6085
Country	:	US
Telephone Number	:	772-219-0405
Fax Number	:

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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