Provider Demographics
NPI:1992539506
Name:BURGESS, ALTON EVAN (DPT)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:EVAN
Last Name:BURGESS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 EXETER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3966
Mailing Address - Country:US
Mailing Address - Phone:901-522-6440
Mailing Address - Fax:901-757-2507
Practice Address - Street 1:2100 EXETER RD STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3966
Practice Address - Country:US
Practice Address - Phone:901-522-6440
Practice Address - Fax:901-757-2507
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist