Provider Demographics
NPI:1770880700
Name:BURKE, KATHLEEN HELEN (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:HELEN
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 1:11320 BURLINGTON ST
Mailing Address - Street 2:APT 359
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2896
Mailing Address - Country:US
Mailing Address - Phone:734-287-2427
Mailing Address - Fax:
Practice Address - Street 1:11320 BURLINGTON ST
Practice Address - Street 2:APT 359
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2896
Practice Address - Country:US
Practice Address - Phone:734-287-2427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist