MEDICARE: MELISSA LYNN BURRILL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5210	AZ

General Provider Information

NPI Number	:	1417045071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNN BURRILL PT

Provider Business Mailing Address
First Line	:	22224 N 21ST PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-6530
Country	:	US
Telephone Number	:	480-473-4991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6320A W UNION HILLS DR
Second Line	:	SUITE 265
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7177
Country	:	US
Telephone Number	:	623-374-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/09/2007

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