Healthcare Provider Details

I. General information

NPI: 1164233045
Provider Name (Legal Business Name): TAYLOR ANSLEY BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N US HIGHWAY 1
JUPITER FL
33477-4482
US

IV. Provider business mailing address

4102 NE CHERI DR
JENSEN BEACH FL
34957-3822
US

V. Phone/Fax

Practice location:
  • Phone: 561-277-9011
  • Fax:
Mailing address:
  • Phone: 772-214-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33558
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: