Individual
MR. JONATHAN NICK BURROUGHS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1995 S MAIN ST, SUITE 801, BLACKSBURG, VA 24060-6637
(540) 951-2703
(540) 953-0873
Mailing address
1995 S MAIN ST, SUITE 801, BLACKSBURG, VA 24060-6637
(540) 951-2703
(540) 953-0873
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305202962
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0575302
AETNA
VA
01
—
259904
MAMSI
VA
01
—
436991
ANTHEM-BLACKSBURG OFFICE
VA
01
—
436992
ANTHEM-PEARISBURG OFFICE
VA
Enumeration date
10/11/2005
Last updated
07/09/2007
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