Provider Demographics
NPI:1568736924
Name:BURCHIM, WARREN THOMAS (LMT)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:THOMAS
Last Name:BURCHIM
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 1:2378 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:VENICE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13147-4127
Mailing Address - Country:US
Mailing Address - Phone:315-406-0359
Mailing Address - Fax:
Practice Address - Street 1:1 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2157
Practice Address - Country:US
Practice Address - Phone:315-704-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025019-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist