Active NPI
Jerry Wayne Burroughs, PT
- Physical Therapist
- Dallas, TX
National Provider Identifier
1376835785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1085850
- Practice address
- 4800 Samuell Blvd
Dallas, TX 75228-6831 - Phone
- (214) 381-6677
- NPI assigned
- May 4, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1085850 | TX | Primary |
Addresses
Primary practice location
4800 Samuell Blvd
Dallas, TX 75228-6831
Mailing address
3142 Timberview Rd
Dallas, TX 75229-5845
Phone (214) 366-1989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1085850 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304467200000",
"number": "1376835785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3142 TIMBERVIEW RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752295845",
"telephone_number": "214-366-1989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 SAMUELL BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752286831",
"telephone_number": "214-381-6677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURROUGHS",
"first_name": "JERRY",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-04",
"last_updated": "2011-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1085850",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.