Provider Demographics
NPI:1497827331
Name:BURNS, DIANE J (LMT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:J
Last Name:BURNS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5187 TRAILING OAKS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258
Mailing Address - Country:US
Mailing Address - Phone:904-608-6452
Mailing Address - Fax:904-880-4941
Practice Address - Street 1:3617 CROWN POINT RD
Practice Address - Street 2:SUITE 9
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-608-6452
Practice Address - Fax:904-880-4941
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA42909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist