Individual
MR. MICHAEL T BURNETT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, CPNMT
Contact information
Practice address
1440 W REPUBLIC RD STE 112, SPRINGFIELD, MO 65807-5754
(417) 719-1591
(417) 719-1591
Mailing address
1440 W REPUBLIC RD STE 112, SPRINGFIELD, MO 65807-5754
(417) 719-1591
(417) 719-7913
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2014021187
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13938631
CAQH
MO
Enumeration date
07/07/2015
Last updated
03/10/2019
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