MEDICARE: JAMIE LEANN BURNETT CMT

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	74715	CA

General Provider Information

NPI Number	:	1740895861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LEANN BURNETT CMT

Provider Business Mailing Address
First Line	:	102 1/2 HILLMONT AVE
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-4849
Country	:	US
Telephone Number	:	562-440-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 1/2 HILLMONT AVE
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-4849
Country	:	US
Telephone Number	:	562-440-7193
Fax Number	:

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

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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