Provider Demographics
NPI:1346638624
Name:KAREN BURKE LMT
Entity Type:Organization
Organization Name:KAREN BURKE LMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUSIE
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:386-689-1800
Mailing Address - Street 1:5300 S ATLANTIC AVE
Mailing Address - Street 2:UNIT 3402
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4573
Mailing Address - Country:US
Mailing Address - Phone:386-689-1800
Mailing Address - Fax:
Practice Address - Street 1:5300 S ATLANTIC AVE
Practice Address - Street 2:UNIT 3402
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-4573
Practice Address - Country:US
Practice Address - Phone:386-689-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA34659OtherMEDICAL MASSAGE THERAPY