Provider Demographics
NPI:1689652836
Name:BURKE, TOD JASON (MPT)
Entity Type:Individual
Prefix:MR
First Name:TOD
Middle Name:JASON
Last Name:BURKE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SQUAW TER
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1294
Mailing Address - Country:US
Mailing Address - Phone:304-279-0109
Mailing Address - Fax:
Practice Address - Street 1:208 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9219
Practice Address - Country:US
Practice Address - Phone:304-671-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist