Provider Demographics
NPI:1780701110
Name:BURNS, TREVOR WILLIAM (MS, ATC)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:WILLIAM
Last Name:BURNS
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 FOX RUN CT
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4578
Mailing Address - Country:US
Mailing Address - Phone:352-219-2128
Mailing Address - Fax:
Practice Address - Street 1:240 EAST ST STE C
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2935
Practice Address - Country:US
Practice Address - Phone:860-793-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer