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NPI Code Detail

MEDICARE: BRAIDEN BURKS DPT

MEDICARE: BRAIDEN BURKS DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT-2023-2344NM

General Provider Information

NPI Number : 1073389631
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAIDEN BURKS DPT
Provider Business Mailing Address
First Line : 4400 N SONOMA RANCH BLVD STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7343
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4400 N SONOMA RANCH BLVD STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7343
Country : US
Telephone Number : 575-222-0188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2023
Last Update Date : 11/27/2023

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Directions to “ BRAIDEN BURKS DPT” Practice Location

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