Provider Demographics
NPI:1033413737
Name:BURGESS, TAMORA S (AAS, LMT)
Entity type:Individual
Prefix:
First Name:TAMORA
Middle Name:S
Last Name:BURGESS
Suffix:
Gender:F
Credentials:AAS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 N 1450 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-8550
Mailing Address - Country:US
Mailing Address - Phone:720-982-7000
Mailing Address - Fax:
Practice Address - Street 1:2777 N 1450 E
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-8550
Practice Address - Country:US
Practice Address - Phone:720-982-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10295225700000X
UT14174661-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist