Tony Burnside Jr., LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501015684 Issued in MI

Practice address

324 E Dewey St Ste 104
Buchanan, MI 49107-1494

Phone

(269) 231-0384

NPI assigned

Feb 25, 2025

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 25, 2025.

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1912704339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 E DEWEY ST STE 104",
            "city": "BUCHANAN",
            "state": "MI",
            "postal_code": "491071494",
            "telephone_number": "269-231-0384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 E DEWEY ST STE 104",
            "city": "BUCHANAN",
            "state": "MI",
            "postal_code": "491071494",
            "telephone_number": "269-231-0384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNSIDE",
        "first_name": "TONY",
        "name_suffix": "Jr.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-25",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IN",
            "license": "MT22408522",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501015684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Michael Berecz, PH.D.
• Stephanie A Blaylock
• Sharon M Bradley, RN
• Harold E Brown, M.D.
• Buchanan Al Operator LLC
• Wayne A Carlson, MD
• Ronald C Carr, DDS
• Olivia Cochran, NP
• Ronald Duane Coffen, PH.D.
• Hannah Mykel Cook, BA, MA, LLMFT, LLPC

• All providers in Buchanan, MI
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.