Provider Demographics
NPI:1013985209
Name:BURKE, JENNIFER MILZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MILZ
Last Name:BURKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9042
Mailing Address - Country:US
Mailing Address - Phone:248-627-4741
Mailing Address - Fax:
Practice Address - Street 1:1255 N OAKLAND BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1582
Practice Address - Country:US
Practice Address - Phone:248-666-3329
Practice Address - Fax:248-666-5372
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist