Provider Demographics
NPI:1871185967
Name:BURKE, PRECIOUS RANDA (ATC)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:RANDA
Last Name:BURKE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256-0632
Mailing Address - Country:US
Mailing Address - Phone:603-381-1174
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03256-4208
Practice Address - Country:US
Practice Address - Phone:603-677-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
32826OtherNATIONAL ATHLETIC TRAINERS' ASSOCIATION
BOC153621OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER
NH0517OtherNEW HAMPSHIRE STATE LICENSURE