Active NPI
Amanda Virginia Burlison, LMT, MMP
- Massage Therapist
- Mount Juliet, TN
National Provider Identifier
1043447923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 8828
- Practice address
- 1032 Willoughby Station Blvd
Mount Juliet, TN 37122-7581 - Phone
- (775) 848-6603
- Fax
- (877) 711-6053
- NPI assigned
- Jun 17, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 187 | NV | |
| Massage Therapist | 225700000X | 8828 | TN | Primary |
Addresses
Primary practice location
1032 Willoughby Station Blvd
Mount Juliet, TN 37122-7581
Mailing address
1032 Willoughby Station Blvd
Mount Juliet, TN 37122-7581
Phone (775) 848-6603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 187 | NV | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329091200000",
"number": "1043447923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1032 WILLOUGHBY STATION BLVD",
"city": "MOUNT JULIET",
"state": "TN",
"postal_code": "371227581",
"telephone_number": "775-848-6603",
"fax_number": "877-711-6053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1032 WILLOUGHBY STATION BLVD",
"city": "MOUNT JULIET",
"state": "TN",
"postal_code": "371227581",
"telephone_number": "775-848-6603",
"fax_number": "877-711-6053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURLISON",
"first_name": "AMANDA",
"middle_name": "VIRGINIA",
"name_prefix": "Mrs.",
"credential": "LMT, MMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-17",
"last_updated": "2012-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NV",
"license": "187",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TN",
"license": "8828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Juliet, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.