Provider Demographics
NPI:1033317839
Name:BURKE, NANCY CLAIRE (ATC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CLAIRE
Last Name:BURKE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11118 HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4315
Mailing Address - Country:US
Mailing Address - Phone:703-629-2038
Mailing Address - Fax:
Practice Address - Street 1:14601 LEE RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1703
Practice Address - Country:US
Practice Address - Phone:703-449-7241
Practice Address - Fax:703-449-7373
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer