Provider Demographics
NPI:1306037494
Name:BURFORD, WILLIAM RAY (LMT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RAY
Last Name:BURFORD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N EASTMAN ROAD
Mailing Address - Street 2:SUITE J #287
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-341-4522
Mailing Address - Fax:
Practice Address - Street 1:BRISTOL REGIONAL MEDICAL CENTER
Practice Address - Street 2:DEPT OF CLINICAL EDUCATION
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-844-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMT1682225700000X
VA0019002993225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist