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NPI Code Detail

MEDICARE: TINA-LORA BURKE P.T.

MEDICARE: TINA-LORA BURKE 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
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician1951NV
2225100000XPhysical Therapist4576NV

Other Identifiers

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

General Provider Information

NPI Number : 1851321459
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA-LORA BURKE P.T.
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 866-370-8206
Fax Number : 517-435-3670
Provider Business Practice Location Address
First Line : 7060 N DURANGO DR STE 130
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4605
Country : US
Telephone Number : 702-826-5749
Fax Number : 702-273-3015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 08/17/2021

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Directions to “ TINA-LORA BURKE P.T.” Practice Location

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