=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780230128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM BURLESON PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2019
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3345 S VAL VISTA DR STE 101
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85297-7331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-857-7123
-----------------------------------------------------
Fax | 480-857-8250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41125 N DAISY MOUNTAIN DR STE 121
-----------------------------------------------------
City | ANTHEM
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086-4964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-265-2132
-----------------------------------------------------
Fax | 623-551-5078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 30808
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------