Provider Demographics
NPI:1659066447
Name:BURRIS, JASMIN R (LMT)
Entity Type:Individual
Prefix:MS
First Name:JASMIN
Middle Name:R
Last Name:BURRIS
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 1:508 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2133
Mailing Address - Country:US
Mailing Address - Phone:972-595-2445
Mailing Address - Fax:
Practice Address - Street 1:3630 W PIONEER PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4534
Practice Address - Country:US
Practice Address - Phone:972-595-2445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT-120041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty