Provider Demographics
NPI:1013217397
Name:BURR, CELESTE MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:MARIE
Last Name:BURR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 N 650 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4905
Mailing Address - Country:US
Mailing Address - Phone:801-473-5545
Mailing Address - Fax:
Practice Address - Street 1:351 N 650 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4905
Practice Address - Country:US
Practice Address - Phone:801-473-5545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7418693-4701172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7418693-4701OtherPROFESSIONAL LICENCE