Provider Demographics
NPI:1891381067
Name:BURTON, MELODY (KINESIOTHERAPIST)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:KINESIOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:TOUGALOO
Mailing Address - State:MS
Mailing Address - Zip Code:39174-0017
Mailing Address - Country:US
Mailing Address - Phone:769-257-7448
Mailing Address - Fax:888-351-3761
Practice Address - Street 1:5040 N STATE ST STE 10-11
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4049
Practice Address - Country:US
Practice Address - Phone:769-257-7448
Practice Address - Fax:888-351-3761
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist