Jeffrey Scott Burleson, PTA

Individual provider Active NPI Physical Therapy Assistant · Whitmire, SC

NPI 1114266376 · NPPES record last updated Feb 7, 2013

Key facts

NPI
1114266376
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
2857 (SC)
Practice address
1911 Little Egypt Rd
Whitmire, SC 29178-9065
Phone
(803) 694-4587
NPI assigned
Feb 7, 2013
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2857SCMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2857 SC Yes

Addresses

Primary practice location

1911 Little Egypt Rd
Whitmire, SC 29178-9065

Mailing address

1911 Little Egypt Rd
Whitmire, SC 29178-9065
Phone (803) 694-4587

Other providers in Whitmire, SC

All providers in Whitmire, SC · Physical Therapy Assistant in South Carolina

Sources for this page

Verify at the official NPI Registry.