Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA72858 | FL |
NPI | 1013404391 |
---|---|
Provider Name | Mrs. Maria Elena Burgett |
First Address | Oviedo, FL 32765-5926 |
Second Address | Orlando, FL 32826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2018 |
Last Update Date | 04/02/2020 |