Provider Demographics
NPI:1649281858
Name:BURKE, KEVIN A (MSPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:BURKE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3858
Mailing Address - Country:US
Mailing Address - Phone:717-840-4149
Mailing Address - Fax:717-840-9049
Practice Address - Street 1:73 E FORREST AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1400
Practice Address - Country:US
Practice Address - Phone:717-235-8525
Practice Address - Fax:717-235-8725
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19260225100000X
PAPT018723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019792400001Medicaid
MD68540608OtherCAREFIRST
PA20066232OtherAMERIHEALTH MERCY
MDR7350008OtherGHMSI
PA50071494OtherCAPITAL BLUE CROSS
PA2857166OtherAM65/PERSONAL CHOICE
PA50071494OtherCAPITAL BLUE CROSS