Provider Demographics
NPI:1235821745
Name:BURTON, JOSHUA (MPT,DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:MPT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2645
Mailing Address - Country:US
Mailing Address - Phone:901-870-7425
Mailing Address - Fax:
Practice Address - Street 1:102 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2645
Practice Address - Country:US
Practice Address - Phone:901-870-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7373208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation