Provider Demographics
NPI:1598738478
Name:BURKE, ANDREW J JR (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:BURKE
Suffix:JR
Gender:M
Credentials:MSPT
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Mailing Address - Street 1:57 STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2911
Mailing Address - Country:US
Mailing Address - Phone:508-747-5372
Mailing Address - Fax:508-746-7211
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-746-6922
Practice Address - Fax:508-746-7211
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA15605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9716271Medicaid
MA9716271Medicaid