Provider Demographics
NPI:1649927823
Name:BURRIS, VICTORIA GRACE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GRACE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 S OAK CIR APT 1306
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5087
Mailing Address - Country:US
Mailing Address - Phone:312-402-4445
Mailing Address - Fax:
Practice Address - Street 1:10488 W CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4293
Practice Address - Country:US
Practice Address - Phone:720-220-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist