Provider Demographics
NPI:1447458641
Name:BURT, LOUIE DOYLE (MS, PT)
Entity type:Individual
Prefix:
First Name:LOUIE
Middle Name:DOYLE
Last Name:BURT
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2345
Mailing Address - Country:US
Mailing Address - Phone:435-656-3324
Mailing Address - Fax:435-986-1037
Practice Address - Street 1:1812 W SUNSET BLVD STE 17
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-6606
Practice Address - Country:US
Practice Address - Phone:435-229-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347017-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist