Provider Demographics
NPI:1821421140
Name:BURKE, MICHAEL JULIAN (SET, SSC, CFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JULIAN
Last Name:BURKE
Suffix:
Gender:M
Credentials:SET, SSC, CFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 POTOMAC DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4418
Mailing Address - Country:US
Mailing Address - Phone:419-788-0718
Mailing Address - Fax:
Practice Address - Street 1:134 POTOMAC DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4418
Practice Address - Country:US
Practice Address - Phone:419-788-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0140900146N00000X
OH391942174400000X
OH391940174400000X
OH391941226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No174400000XOther Service ProvidersSpecialist