Provider Demographics
NPI:1467163956
Name:BURFORD, COLE EDWARD (LMT)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:EDWARD
Last Name:BURFORD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W BIRCH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4407
Mailing Address - Country:US
Mailing Address - Phone:541-550-9597
Mailing Address - Fax:
Practice Address - Street 1:318 W BIRCH AVE STE 5
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4407
Practice Address - Country:US
Practice Address - Phone:541-550-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27869225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist