Provider Demographics
NPI:1043451487
Name:BURK, DONNA DAVIS (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:DAVIS
Last Name:BURK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-3262
Mailing Address - Country:US
Mailing Address - Phone:501-676-2786
Mailing Address - Fax:
Practice Address - Street 1:205 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3749
Practice Address - Country:US
Practice Address - Phone:501-628-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT987174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist