MEDICARE: JACQUELINE BURNETT

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	MA51501	FL

General Provider Information

NPI Number	:	1750619953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BURNETT

Provider Business Mailing Address
First Line	:	664 SE 20TH AVE
Second Line	:	#24
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-5106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	664 SE 20TH AVE
Second Line	:	#24
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-5106
Country	:	US
Telephone Number	:	954-854-1744
Fax Number	:

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

Provider Enumeration Date	:	11/27/2009
Last Update Date	:	11/27/2009

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Directions to “ JACQUELINE BURNETT ” Practice Location

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