Provider Demographics
NPI:1003935255
Name:BURTON, CHRISTIE FAYE (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:FAYE
Last Name:BURTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 SANDRA ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-2416
Mailing Address - Country:US
Mailing Address - Phone:901-385-3877
Mailing Address - Fax:907-385-3874
Practice Address - Street 1:6570 STAGE RD STE 245
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2840
Practice Address - Country:US
Practice Address - Phone:901-385-3877
Practice Address - Fax:901-385-3874
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist