Provider Demographics
NPI:1154337293
Name:REED, BURTON R (PT, OCS, FAAOMPT)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:R
Last Name:REED
Suffix:
Gender:M
Credentials:PT, OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:1720 SE 16TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4620
Practice Address - Country:US
Practice Address - Phone:352-512-0825
Practice Address - Fax:352-512-0826
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001444225100000X
PAPT020396225100000X
OHPT 012836225100000X
FLPT28046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0300067000Medicaid
FL016201500Medicaid
P00352735OtherRAILROAD MEDICARE
OH2702632Medicaid
WV886384Medicare PIN
OH4294821Medicare PIN
FLHS516ZMedicare PIN