Individual
KELLY MCNABB BURGENSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1816 PRAIRIE LAKE BLVD, OCOEE, FL 34761
(321) 945-7030
Mailing address
16 JOINER STREET, WINTER GARDEN, FL 34787-4204
(321) 945-7030
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
27030
FL
Other
Enumeration date
07/20/2007
Last updated
03/01/2012
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