Healthcare Provider Details

I. General information

NPI: 1780230128
Provider Name (Legal Business Name): WILLIAM BURLESON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 S VAL VISTA DR STE 101
GILBERT AZ
85297-7331
US

IV. Provider business mailing address

41125 N DAISY MOUNTAIN DR STE 121
ANTHEM AZ
85086-4964
US

V. Phone/Fax

Practice location:
  • Phone: 480-857-7123
  • Fax: 480-857-8250
Mailing address:
  • Phone: 480-265-2132
  • Fax: 623-551-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30808
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: