MEDICARE: MS. SAMANTHA A BURNS L.M.P.

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	MA00012903	WA

General Provider Information

NPI Number	:	1710050364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMANTHA A BURNS L.M.P.

Provider Business Mailing Address
First Line	:	PO BOX 31544
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-1544
Country	:	US
Telephone Number	:	206-903-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 STONE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8000
Country	:	US
Telephone Number	:	206-903-9633
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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