MEDICARE: MR. DAVID BURCH LMP

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	MA00023106	WA

General Provider Information

NPI Number	:	1750449757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID BURCH LMP

Provider Business Mailing Address
First Line	:	8910 LAWNDALE AVE SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-2422
Country	:	US
Telephone Number	:	253-203-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	9633 GRAVELLY LAKE DR SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-1515
Country	:	US
Telephone Number	:	253-584-3230
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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