Provider Demographics
NPI:1437444726
Name:BURKE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BURKE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-329-1299
Mailing Address - Street 1:3401 WESTGROVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-5015
Mailing Address - Country:US
Mailing Address - Phone:601-329-1299
Mailing Address - Fax:
Practice Address - Street 1:2927 KERRY FOREST PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-7815
Practice Address - Country:US
Practice Address - Phone:601-329-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24543261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy