Greg R Burton, PT
Individual provider Active NPI Physical Therapist · Lovell, WY
NPI 1104924877 · NPPES record last updated Feb 16, 2021
Key facts
- NPI
- 1104924877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 3193 (NV)
- Practice address
- 186 E Main St Ste 331
Lovell, WY 82431-2004 - Phone
- (307) 887-6202
- Fax
- (702) 474-7458
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
186 E Main St
Lovell, WY 82431-2004
Phone (307) 887-6202
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051018000825 | WY | Practitioner - Physical Therapist in Private Practice | 3678599750 |
Reassigns benefits to 1 organization Practice locations: Lovell, WY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 768 | WY | MD | Chiropractor |
| PT768 | WY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pivotal Physical Therapy, LLC | Physical Therapist | Current |
Accepting new patients |
| Aspen Physical Therapy LLC | Physical Therapist | Past |
Accepting new patients |
Locations
186 E Main St
Ste 331
Lovell, WY 82431
Phone (307) 887-6202
186 E Main St
Lovell, WY 82431
Phone (307) 887-6202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT768 | WY | |
| Physical Therapist | 225100000X | 3193 | NV | Yes |
Addresses
Primary practice location
186 E Main St Ste 331
Lovell, WY 82431-2004
Mailing address
PO Box 395
Lovell, WY 82431-0395
Phone (307) 887-6202
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117014700 | Medicaid | WY | |
| 308087 | Other | WY | BLUE CROSS BLUE SHIELD |
Other providers in Lovell, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.