Provider Demographics
NPI:1285518746
Name:BURGESS, JOANNA (LMT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BURGESS
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 1:3147 S NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:HAW RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:27258-9788
Mailing Address - Country:US
Mailing Address - Phone:707-790-7364
Mailing Address - Fax:
Practice Address - Street 1:1311 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5603
Practice Address - Country:US
Practice Address - Phone:510-239-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist