Provider Demographics
NPI:1093214736
Name:BURKE COLLINS THERAPY, INC
Entity Type:Organization
Organization Name:BURKE COLLINS THERAPY, INC
Other - Org Name:BACK TO WORK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLETON
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-253-3092
Mailing Address - Street 1:PO BOX 3147
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-3147
Mailing Address - Country:US
Mailing Address - Phone:813-253-3092
Mailing Address - Fax:813-259-9516
Practice Address - Street 1:11809 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3505
Practice Address - Country:US
Practice Address - Phone:813-253-3092
Practice Address - Fax:813-259-9516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURKE COLLINS THERAPY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty