Provider Demographics
NPI:1376777540
Name:BURNETT, VERONICA DAYE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:DAYE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 HOLCOMB BRIDGE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4385
Mailing Address - Country:US
Mailing Address - Phone:678-765-1893
Mailing Address - Fax:
Practice Address - Street 1:920 HOLCOMB BRIDGE RD
Practice Address - Street 2:STE 300
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4385
Practice Address - Country:US
Practice Address - Phone:678-765-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X, 225500000X
GAMT002952174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist