Healthcare Provider Details

I. General information

NPI: 1144239419
Provider Name (Legal Business Name): JOY LADAWN BURKHALL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3046 W 12TH PL
YUMA AZ
85364-4269
US

IV. Provider business mailing address

3046 W 12TH PL
YUMA AZ
85364-4269
US

V. Phone/Fax

Practice location:
  • Phone: 928-246-4658
  • Fax:
Mailing address:
  • Phone: 928-246-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number3642
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: