Provider Demographics
NPI:1871811166
Name:BURTON-TEED, BLYTHE (NMD)
Entity type:Individual
Prefix:DR
First Name:BLYTHE
Middle Name:
Last Name:BURTON-TEED
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3622
Mailing Address - Country:US
Mailing Address - Phone:480-522-8144
Mailing Address - Fax:480-985-0029
Practice Address - Street 1:5416 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3622
Practice Address - Country:US
Practice Address - Phone:480-522-8144
Practice Address - Fax:480-985-0029
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1183175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath