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General NPI Number Information
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NPI Number | 1750899464
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Entity Type | Individual
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Provider Name | DONALYN JODY BURKS LMT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 2049 E CHERRY ST STE 300
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City | SPRINGFIELD
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State | MO
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Zip | 65802-2954
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Country | US
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Telephone | 417-818-1217
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Fax |
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Provider Business Mailing Address
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Address Line | 768 FELLOWSHIP RD
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City | MARSHFIELD
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State | MO
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Zip | 65706-8992
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Country | US
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Telephone | 417-818-1217
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2015002665
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License Number State | MO
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