Provider Demographics
NPI:1598378952
Name:BURKE, PATRIC (CMT)
Entity Type:Individual
Prefix:
First Name:PATRIC
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14600 34TH AVE N APT 307
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5226
Mailing Address - Country:US
Mailing Address - Phone:763-350-5217
Mailing Address - Fax:
Practice Address - Street 1:409 TERRITORIAL ROAD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MN
Practice Address - Zip Code:55388
Practice Address - Country:US
Practice Address - Phone:763-350-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist