Provider Demographics
NPI:1023561743
Name:BURKS, HALEY CAMILLE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:HALEY
Middle Name:CAMILLE
Last Name:BURKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 AIRPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2822
Mailing Address - Country:US
Mailing Address - Phone:817-797-0817
Mailing Address - Fax:
Practice Address - Street 1:1008 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2823
Practice Address - Country:US
Practice Address - Phone:850-837-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist