Provider Demographics
NPI:1649577917
Name:BURNETT, MARK T (MT-BC, NMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:BURNETT
Suffix:
Gender:M
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7347 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7061
Mailing Address - Country:US
Mailing Address - Phone:612-267-5109
Mailing Address - Fax:
Practice Address - Street 1:7347 DERBY LN
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-7061
Practice Address - Country:US
Practice Address - Phone:612-267-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist