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Individual

MISS MALIA ALYS BURGESS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
12400 HIGH BLUFF DR, SAN DIEGO, CA 92130-3077
(866) 871-8519
Mailing address
2125 CLEARVIEW AVE, FORT COLLINS, CO 80521-4209
(360) 201-8573

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
P160043572
WA
225200000X
Physical Therapy Assistant
Primary
PTA-12149
CO

Other

Enumeration date
06/26/2012
Last updated
06/26/2012
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