Provider Demographics
NPI:1043447923
Name:BURLISON, AMANDA VIRGINIA (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:VIRGINIA
Last Name:BURLISON
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 WILLOUGHBY STATION BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7581
Mailing Address - Country:US
Mailing Address - Phone:775-848-6603
Mailing Address - Fax:877-711-6053
Practice Address - Street 1:1032 WILLOUGHBY STATION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7581
Practice Address - Country:US
Practice Address - Phone:775-848-6603
Practice Address - Fax:877-711-6053
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV187225700000X
TN8828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist