Provider Demographics
NPI:1184977290
Name:BURKETT, BROOKE KATHRYN (LMP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:KATHRYN
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LMP
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 12550
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-2550
Mailing Address - Country:US
Mailing Address - Phone:206-852-2241
Mailing Address - Fax:
Practice Address - Street 1:3220 MISSION BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9736
Practice Address - Country:US
Practice Address - Phone:206-852-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60244060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist