Provider Demographics
NPI:1679921555
Name:BURLESON, KATHRYN (CERTIFIED ROLFER)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BURLESON
Suffix:
Gender:F
Credentials:CERTIFIED ROLFER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WINTERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4669
Mailing Address - Country:US
Mailing Address - Phone:828-773-5511
Mailing Address - Fax:
Practice Address - Street 1:838 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5307
Practice Address - Country:US
Practice Address - Phone:828-773-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist