Provider Demographics
NPI:1598208746
Name:BURNETT BODY MECHANICS LLC
Entity Type:Organization
Organization Name:BURNETT BODY MECHANICS LLC
Other - Org Name:BODY MECHANICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:417-719-1591
Mailing Address - Street 1:1948E S GLENSTONE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2364
Mailing Address - Country:US
Mailing Address - Phone:417-719-1591
Mailing Address - Fax:417-719-7913
Practice Address - Street 1:1948E S GLENSTONE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2364
Practice Address - Country:US
Practice Address - Phone:417-719-1591
Practice Address - Fax:417-719-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014021187251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare