Individual
DIANE M. BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMMP, LMT
Contact information
Practice address
1214 W PIONEER DR, IRVING, TX 75061-7308
(214) 507-1738
(972) 790-5099
Mailing address
2226 DRUID DR, IRVING, TX 75060-5011
(214) 507-1738
(972) 790-5099
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT014585
TX
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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