Basic Information
| Provider Information | |||||||||
| NPI: | 1154337293 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | REED | ||||||||
| FirstName: | BURTON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PT, OCS, FAAOMPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 36TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261011005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049173660 | ||||||||
| FaxNumber: | 3049173674 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 SE 16TH AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525120825 | ||||||||
| FaxNumber: | 3525120826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 001444 | WV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT020396 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT 012836 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT28046 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0300067000 | 05 | WV | MEDICAID | 016201500 | 05 | FL | MEDICAID | P00352735 | 01 | RAILROAD MEDICARE | OTHER | 2702632 | 05 | OH | MEDICAID |