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General NPI Number Information
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NPI Number | 1063905081
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Entity Type | Individual
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Provider Name | ASHLEY MARIE BURGESS DPT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 4066 E MONSANTO DR STE E
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-8512
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Country | US
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Telephone | 702-416-6997
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Fax |
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Provider Business Mailing Address
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Address Line | 6466 MONDELL PINES CIR
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City | LAS VEGAS
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State | NV
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Zip | 89146-6644
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Country | US
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Telephone | 702-416-6997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3601
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013590
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 60848943
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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