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General NPI Number Information
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NPI Number | 1497094668
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Entity Type | Individual
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Provider Name | MICHELLE R BURBERRY MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 780 US 1 UNIT 201
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City | VERO BEACH
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State | FL
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Zip | 32962-1662
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Country | US
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Telephone | 772-202-0572
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Fax |
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Provider Business Mailing Address
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Address Line | 250 PROVENCE PL
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City | VERO BEACH
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State | FL
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Zip | 32960-7068
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Country | US
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Telephone | 772-202-0572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.07819
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA27188
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA100928
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License Number State | FL
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