Provider Demographics
NPI:1497829535
Name:BURKS, LARRY HUGH (PT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:HUGH
Last Name:BURKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 PERIMETER PARK DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0922
Mailing Address - Country:US
Mailing Address - Phone:931-526-2345
Mailing Address - Fax:931-528-1460
Practice Address - Street 1:1140 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0922
Practice Address - Country:US
Practice Address - Phone:931-526-2345
Practice Address - Fax:931-528-1460
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0095650OtherBLUECROSS BLUESHIELD INDI
TN0095650OtherBLUECROSS BLUESHIELD INDI