MEDICARE: BURTON WELLNESS AND INJURY CENTER

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	332900000X	Non-Pharmacy Dispensing Site	MD031220E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3986378	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1902910896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURTON WELLNESS AND INJURY CENTER

Provider Business Mailing Address
First Line	:	1455 CITY AVE
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3820
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 CITY AVE
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3820
Country	:	US
Telephone Number	:	610-649-4325
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DIANE BURTON
Credential	:
Telephone Number	:	610-649-4325

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/22/2020

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