Provider Demographics
NPI:1912243205
Name:BURTON, HOLLY (LMT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BURTON
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 1:223 MEADOW ST
Mailing Address - Street 2:#3
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4043
Mailing Address - Country:US
Mailing Address - Phone:303-547-4309
Mailing Address - Fax:
Practice Address - Street 1:223 MEADOW ST
Practice Address - Street 2:#3
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4043
Practice Address - Country:US
Practice Address - Phone:303-547-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist