Provider Demographics
NPI:1144239419
Name:BURKHALL, JOY LADAWN (PT)
Entity Type:Individual
Prefix:MISS
First Name:JOY
Middle Name:LADAWN
Last Name:BURKHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3046 W 12TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4269
Mailing Address - Country:US
Mailing Address - Phone:928-246-4658
Mailing Address - Fax:
Practice Address - Street 1:3046 W 12TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4269
Practice Address - Country:US
Practice Address - Phone:928-246-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3642171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor