Provider Demographics
NPI:1659108694
Name:BURTOFT, CHRISTY LEE
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEE
Last Name:BURTOFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 STRATFORDSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2249
Mailing Address - Country:US
Mailing Address - Phone:850-228-2964
Mailing Address - Fax:
Practice Address - Street 1:1168 CAPITAL CIR SE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3832
Practice Address - Country:US
Practice Address - Phone:850-765-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist