Provider Demographics
NPI:1710118096
Name:BURNHAM, JANIE (CMT)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 JFK PKWY UNIT 11F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3087
Mailing Address - Country:US
Mailing Address - Phone:970-204-2051
Mailing Address - Fax:970-204-6812
Practice Address - Street 1:3938 JFK PKWY UNIT 11F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3087
Practice Address - Country:US
Practice Address - Phone:970-204-2051
Practice Address - Fax:970-204-6812
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6868174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO352309556OtherMEDICAL MASSAGE