Provider Demographics
NPI:1992141956
Name:BURROUS, JASON COLE (CPTA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:COLE
Last Name:BURROUS
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:KS
Mailing Address - Zip Code:66549-9836
Mailing Address - Country:US
Mailing Address - Phone:785-370-5043
Mailing Address - Fax:
Practice Address - Street 1:2011 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1159
Practice Address - Country:US
Practice Address - Phone:785-456-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03605225200000X
KS1402520225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant