Provider Demographics
NPI:1669691382
Name:BURTON, GREG (PTA)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-6735
Mailing Address - Country:US
Mailing Address - Phone:870-231-4232
Mailing Address - Fax:870-836-1346
Practice Address - Street 1:1201 MAUL RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-2743
Practice Address - Country:US
Practice Address - Phone:870-837-8484
Practice Address - Fax:870-837-8490
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2120225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant