MEDICARE: ALEXANDRA LYNNE BURTON LMT

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	225700000X	Massage Therapist	12124	OR

General Provider Information

NPI Number	:	1326168691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LYNNE BURTON LMT

Provider Business Mailing Address
First Line	:	1534 SE MAIN ST APT 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-3756
Country	:	US
Telephone Number	:	503-327-9547
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 SE BELMONT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2812
Country	:	US
Telephone Number	:	503-234-0119
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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