Provider Demographics
NPI:1649010166
Name:BURKE, KIMBERLEE ASHLEY (LMT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:ASHLEY
Last Name:BURKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KIMBERLEE
Other - Middle Name:ASHLEY
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RMP
Mailing Address - Street 1:8303 PULASKI HWY STE A
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2962
Mailing Address - Country:US
Mailing Address - Phone:667-201-3440
Mailing Address - Fax:443-505-8163
Practice Address - Street 1:8303 PULASKI HWY STE A
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2962
Practice Address - Country:US
Practice Address - Phone:667-201-3440
Practice Address - Fax:443-505-8163
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist