Healthcare Provider Details

I. General information

NPI: 1376777540
Provider Name (Legal Business Name): VERONICA DAYE BURNETT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 HOLCOMB BRIDGE RD STE 300
ROSWELL GA
30076-4385
US

IV. Provider business mailing address

920 HOLCOMB BRIDGE RD STE 300
ROSWELL GA
30076-4385
US

V. Phone/Fax

Practice location:
  • Phone: 678-765-1893
  • Fax:
Mailing address:
  • Phone: 678-765-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT002952
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT002952
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: