Provider Demographics
NPI:1477043982
Name:BURKE, LAURA JEANETTE (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANETTE
Last Name:BURKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:704-316-3850
Mailing Address - Fax:704-316-1755
Practice Address - Street 1:8420 UNIVERSITY EXEC PARK DR STE 850
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1308
Practice Address - Country:US
Practice Address - Phone:704-316-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211885225100000X
NCP20337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305211885OtherVIRGINIA BOARD OF PHYSICAL THERAPY