Active NPI
Stephenson Keith Burleson, DPT
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1508015066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT23208
- Practice address
- 6910 Atlantic Blvd
Jacksonville, FL 32211-8704 - Phone
- (904) 805-0099
- Fax
- (904) 805-0755
- NPI assigned
- Sep 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | PT23208 | FL | Primary |
Addresses
Primary practice location
6910 Atlantic Blvd
Jacksonville, FL 32211-8704
Mailing address
6910 Atlantic Blvd
Jacksonville, FL 32211-8704
Phone (904) 805-0099
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 |
|---|---|---|---|
| PT23208 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265241600000",
"number": "1508015066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6910 ATLANTIC BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322118704",
"telephone_number": "904-805-0099",
"fax_number": "904-805-0755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6910 ATLANTIC BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322118704",
"telephone_number": "904-805-0099",
"fax_number": "904-805-0755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURLESON",
"first_name": "STEPHENSON",
"middle_name": "KEITH",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-09",
"last_updated": "2010-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT23208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.