Provider Demographics
NPI:1710998042
Name:BURKE, HEATHER LEE (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:BURKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 1/2 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:617-504-9793
Mailing Address - Fax:
Practice Address - Street 1:63 1/2 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:617-504-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY67608OtherBLUE CROSS/BLUE SHIELD
MA3279520OtherAETNA
MABUY68233Medicare ID - Type Unspecified