Provider Demographics
NPI:1750899464
Name:BURKS, DONALYN JODY (LMT)
Entity type:Individual
Prefix:
First Name:DONALYN
Middle Name:JODY
Last Name:BURKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-8992
Mailing Address - Country:US
Mailing Address - Phone:417-818-1217
Mailing Address - Fax:
Practice Address - Street 1:2049 E CHERRY ST STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2954
Practice Address - Country:US
Practice Address - Phone:417-818-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002665225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty