Provider Demographics
NPI:1912203837
Name:BURKE, MARILYN ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BEVINS LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6139
Mailing Address - Country:US
Mailing Address - Phone:859-797-4343
Mailing Address - Fax:
Practice Address - Street 1:204 BEVINS LN
Practice Address - Street 2:SUITE D
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6139
Practice Address - Country:US
Practice Address - Phone:859-797-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist