Healthcare Provider Details

I. General information

NPI: 1083578199
Provider Name (Legal Business Name): TREVOR BURROLA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 310
PHOENIX AZ
85016-4879
US

IV. Provider business mailing address

3935 E ROUGH RIDER RD UNIT 1101
PHOENIX AZ
85050-7353
US

V. Phone/Fax

Practice location:
  • Phone: 602-512-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: