MEDICARE: ANGELA BURNS LMT, MMP

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	MA74523	FL

General Provider Information

NPI Number	:	1679989131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA BURNS LMT, MMP

Provider Business Mailing Address
First Line	:	6730 MOSSY GLEN DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4772
Country	:	US
Telephone Number	:	708-204-4562
Fax Number	:

Provider Business Practice Location Address
First Line	:	9407 CYPRESS LAKE DR
Second Line	:	SUITE C
City	:	FORT MYERS
State	:	FL
Zip	:	33919-0910
Country	:	US
Telephone Number	:	239-333-1450
Fax Number	:

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

Provider Enumeration Date	:	07/05/2014
Last Update Date	:	07/05/2014

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