Provider Demographics
NPI:1760681977
Name:BURK, NANCY KATHLEEN (PTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:KATHLEEN
Last Name:BURK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 EUTAW DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8936
Mailing Address - Country:US
Mailing Address - Phone:704-843-9556
Mailing Address - Fax:
Practice Address - Street 1:11230 BALLANTYNE TRACE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2791
Practice Address - Country:US
Practice Address - Phone:704-341-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1428225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant