Provider Demographics
NPI:1881888337
Name:BURDEN, MITZY D (PT)
Entity type:Individual
Prefix:
First Name:MITZY
Middle Name:D
Last Name:BURDEN
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 1:1252 COUNTY RD 8
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80435
Mailing Address - Country:US
Mailing Address - Phone:970-262-7420
Mailing Address - Fax:970-262-7460
Practice Address - Street 1:1252 COUNTY RD 8
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:CO
Practice Address - Zip Code:80435
Practice Address - Country:US
Practice Address - Phone:970-262-7420
Practice Address - Fax:970-262-7460
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist