Provider Demographics
NPI:1730292459
Name:BURKE, KIM M (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:BURKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:M
Other - Last Name:MEISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7110 JORDAN DR.
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-342-4412
Mailing Address - Fax:605-342-4211
Practice Address - Street 1:7110 JORDAN DR.
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-342-4412
Practice Address - Fax:605-342-4211
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1316OtherLICENSE
SD5838202Medicaid