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NPI Code Detail

MEDICARE: KRISTIN MARIE BURDETT MASSAGE THERAPIST

MEDICARE: KRISTIN MARIE BURDETT MASSAGE THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist4227AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14227OTHERARMASSAGE THERAPY LICENSE

General Provider Information

NPI Number : 1033222740
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN MARIE BURDETT MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 636 WEST BROADWAY
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114
Country : US
Telephone Number : 501-374-1153
Fax Number : 501-374-6213
Provider Business Practice Location Address
First Line : 636 W BROADWAY ST
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114-5526
Country : US
Telephone Number : 501-374-1153
Fax Number : 501-374-6213
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 07/08/2007

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