Provider Demographics
NPI:1215486923
Name:BURR, DAVYNNE TEALESA (DPT)
Entity type:Individual
Prefix:
First Name:DAVYNNE
Middle Name:TEALESA
Last Name:BURR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DAVYNNE
Other - Middle Name:TEALESA
Other - Last Name:ATANASOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:643 CYAN CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1133
Mailing Address - Country:US
Mailing Address - Phone:505-486-6848
Mailing Address - Fax:
Practice Address - Street 1:505 ELM ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2500
Practice Address - Country:US
Practice Address - Phone:505-727-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist