Provider Demographics
NPI:1659826907
Name:BURROUS, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BURROUS
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 1:7310 N 16TH ST STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-8214
Mailing Address - Country:US
Mailing Address - Phone:480-773-1207
Mailing Address - Fax:
Practice Address - Street 1:7310 N 16TH ST STE 180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-8214
Practice Address - Country:US
Practice Address - Phone:480-773-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist