1033382544 NPI number — MR. JOHN ROSEVEAR BURTON JR. MSPT

Table of content: MR. JOHN ROSEVEAR BURTON JR. MSPT (NPI 1033382544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033382544 NPI number — MR. JOHN ROSEVEAR BURTON JR. MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
JOHN
Provider Middle Name:
ROSEVEAR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MSPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033382544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306393
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37230-6393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-373-1350
Provider Business Mailing Address Fax Number:
615-221-9054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19101 LIMESTONE COMMERCIAL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-710-3235
Provider Business Practice Location Address Fax Number:
512-710-3236
Provider Enumeration Date:
04/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6353 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 1166150 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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