Provider Demographics
NPI:1285412924
Name:BURGESS, MELISSA E (NCLMBT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:BURGESS
Suffix:
Gender:F
Credentials:NCLMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SILVA TERRA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2373
Mailing Address - Country:US
Mailing Address - Phone:910-975-1932
Mailing Address - Fax:
Practice Address - Street 1:5 SILVA TERRA DR STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2373
Practice Address - Country:US
Practice Address - Phone:910-975-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist