Provider Demographics
NPI:1124199575
Name:BURGESS, JAMES (LMT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BURGESS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WHEELER HILL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-1605
Mailing Address - Country:US
Mailing Address - Phone:860-349-4325
Mailing Address - Fax:
Practice Address - Street 1:26 WHEELER HILL DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-1605
Practice Address - Country:US
Practice Address - Phone:860-349-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist