Healthcare Provider Details

I. General information

NPI: 1528138906
Provider Name (Legal Business Name): JENNIFER D BURROW LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S 23RD ST SUITE 210
TACOMA WA
98405-1605
US

IV. Provider business mailing address

PO BOX 731269
PUYALLUP WA
98373-0060
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-8684
  • Fax: 253-284-0450
Mailing address:
  • Phone: 253-840-2313
  • Fax: 253-840-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018560
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: