Jonathan Lyle Burlingame

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12214 Issued in MN

Practice address

1006 Crocus Hill St E
Park Rapids, MN 56470-5419

Phone

(218) 366-8469

NPI assigned

Jun 10, 2021

Last updated

Jan 29, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1093382707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25730 HOLLY ROAD",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "56470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 CROCUS HILL ST E",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564705419",
            "telephone_number": "218-366-8469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 5th St NW Ste B",
            "address_purpose": "LOCATION",
            "city": "Bemidji",
            "state": "MN",
            "postal_code": "566012933",
            "country_code": "US",
            "telephone_number": "218-333-4735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURLINGAME",
        "first_name": "JONATHAN",
        "middle_name": "LYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-10",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Park Rapids, MN
• Providers in Park Rapids, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.