Healthcare Provider Details

I. General information

NPI: 1972004885
Provider Name (Legal Business Name): DR. MACKENZIE BURK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 E 101ST PL
COMMERCE CITY CO
80022-9144
US

IV. Provider business mailing address

14651 DALLAS PKWY STE 200
DALLAS TX
75254-8856
US

V. Phone/Fax

Practice location:
  • Phone: 952-715-1875
  • Fax:
Mailing address:
  • Phone: 952-715-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTL.0017790
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: