Provider Demographics
NPI:1568852234
Name:BURKE COLLINS THERAPY, INC
Entity Type:Organization
Organization Name:BURKE COLLINS THERAPY, INC
Other - Org Name:BACK TO WORK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLETON
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:813-253-3902
Mailing Address - Street 1:PO BOX 3147
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-3147
Mailing Address - Country:US
Mailing Address - Phone:813-253-3092
Mailing Address - Fax:813-259-9516
Practice Address - Street 1:10960 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4701
Practice Address - Country:US
Practice Address - Phone:813-253-3092
Practice Address - Fax:813-259-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68-66502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRT1OtherBLUE CROSS BLUE SHIELD
FL68-6650OtherOUTPATIENT REHABILITATION FACILITY