MEDICARE: BURTON MANSEL FORD PT

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	8418	AZ

General Provider Information

NPI Number	:	1952541344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BURTON MANSEL FORD PT

Provider Business Mailing Address
First Line	:	2620 N 3RD ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1153
Country	:	US
Telephone Number	:	602-277-0084
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 N 3RD ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1153
Country	:	US
Telephone Number	:	602-277-0084
Fax Number	:

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

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	02/25/2009

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Directions to “ BURTON MANSEL FORD PT” Practice Location

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