Provider Demographics
NPI:1578807616
Name:BURKE, MATTHEW DEREK (DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DEREK
Last Name:BURKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 CANYON RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1900
Mailing Address - Country:US
Mailing Address - Phone:205-822-8320
Mailing Address - Fax:205-822-8323
Practice Address - Street 1:2017 CANYON RD
Practice Address - Street 2:SUITE 21
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1900
Practice Address - Country:US
Practice Address - Phone:205-822-8320
Practice Address - Fax:205-822-8323
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist