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NPI Code Detail

MEDICARE: MR. TOD JASON BURKE M.P.T.

MEDICARE: MR. TOD JASON BURKE M.P.T.
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 Therapist002522WV

General Provider Information

NPI Number : 1689652836
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TOD JASON BURKE M.P.T.
Provider Business Mailing Address
First Line : 108 SQUAW TER
Second Line :
City : MARTINSBURG
State : WV
Zip : 25403-1294
Country : US
Telephone Number : 304-279-0109
Fax Number :
Provider Business Practice Location Address
First Line : 208 OLD MILL RD
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-9219
Country : US
Telephone Number : 304-671-9604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2006
Last Update Date : 11/09/2022

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