Provider Demographics
NPI:1932491628
Name:BURTON, STEPHEN L (LMT, CHA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:BURTON
Suffix:
Gender:M
Credentials:LMT, CHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 S 96TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-3114
Mailing Address - Country:US
Mailing Address - Phone:480-830-9288
Mailing Address - Fax:
Practice Address - Street 1:215 S POWER RD
Practice Address - Street 2:STE. 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5235
Practice Address - Country:US
Practice Address - Phone:480-830-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT15474172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist