MEDICARE: MR. ANDREW J BURKE JR. MSPT

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
1	225100000X	Physical Therapist	15605	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598738478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW J BURKE JR. MSPT

Provider Business Mailing Address
First Line	:	57 STAFFORD ST
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2911
Country	:	US
Telephone Number	:	508-747-5372
Fax Number	:	508-746-7211

Provider Business Practice Location Address
First Line	:	110 LONG POND RD
Second Line	:	SUITE 111
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2642
Country	:	US
Telephone Number	:	508-746-6922
Fax Number	:	508-746-7211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	07/08/2007

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