Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1891381067 |
---|---|
Provider Name | Melody Burton |
First Address | Tougaloo, MS 39174-0017 |
Second Address | Jackson, MS 39206-4049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2020 |
Last Update Date | 11/12/2020 |