Provider Demographics
NPI:1871832824
Name:BURNETT, MICHAEL ANTHONY (LMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:BURNETT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BIERER LN
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3117
Mailing Address - Country:US
Mailing Address - Phone:724-439-1088
Mailing Address - Fax:
Practice Address - Street 1:309 BERING ST.
Practice Address - Street 2:#1809
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-1809
Practice Address - Country:US
Practice Address - Phone:907-434-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004224172M00000X
AK101402225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist