MEDICARE: HOLLY A BURTON RD

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
1	133V00000X	Registered Dietitian	DT06084	TX

General Provider Information

NPI Number	:	1124572524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY A BURTON RD

Provider Business Mailing Address
First Line	:	1140 CYPRESS STATION DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-3045
Country	:	US
Telephone Number	:	281-440-5300
Fax Number	:	832-232-5591

Provider Business Practice Location Address
First Line	:	1140 CYPRESS STATION DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-3045
Country	:	US
Telephone Number	:	281-440-5300
Fax Number	:	832-232-5591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	10/28/2016

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Directions to “ HOLLY A BURTON RD” Practice Location

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