Healthcare Provider Details

I. General information

NPI: 1902686553
Provider Name (Legal Business Name): KIMBERLY RENEE BURTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 6TH AVE
BROOKINGS SD
57006-2042
US

IV. Provider business mailing address

19827 453RD AVE
ARLINGTON SD
57212-5511
US

V. Phone/Fax

Practice location:
  • Phone: 605-657-8416
  • Fax:
Mailing address:
  • Phone: 515-320-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT12022
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: