MEDICARE: MS. SUSAN D BURNHAM P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6230	AZ

General Provider Information

NPI Number	:	1528102746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN D BURNHAM P.T.

Provider Business Mailing Address
First Line	:	7701 N MOONLIGHT LN
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-2936
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Provider Business Practice Location Address
First Line	:	7540 N 19TH AVE
Second Line	:	STE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7967
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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