MEDICARE: MR. ERIC S. BURNESS DPT

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	28940	AZ
2	225100000X	Physical Therapist	006976	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619050614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC S. BURNESS DPT

Provider Business Mailing Address
First Line	:	4425 E AGAVE RD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-0620
Country	:	US
Telephone Number	:	480-785-1043
Fax Number	:	480-785-1124

Provider Business Practice Location Address
First Line	:	4425 E AGAVE RD STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-0620
Country	:	US
Telephone Number	:	480-785-1043
Fax Number	:	480-785-1124

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	03/13/2021

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