MEDICARE: JOSIE BURCIAGA LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT132233	TX

General Provider Information

NPI Number	:	1699359588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIE BURCIAGA LMT

Provider Business Mailing Address
First Line	:	1101 W 7TH ST APT 414
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 MAIN ST APT 103
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-2523
Country	:	US
Telephone Number	:	817-987-5599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	05/07/2021

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Directions to “ JOSIE BURCIAGA LMT” Practice Location

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