Provider Demographics
NPI:1508931114
Name:LARRY H. BURKS
Entity Type:Organization
Organization Name:LARRY H. BURKS
Other - Org Name:PUTNAM PHYSICAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:931-526-2345
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0095650OtherBLUECROSS BLUESHIELD
TN3725443Medicare ID - Type Unspecified