Healthcare Provider Details

I. General information

NPI: 1821002635
Provider Name (Legal Business Name): ROBERT JOSEPH BURKE RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

15 N SUMMER ST
ADAMS MA
01220-1541
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-7700
  • Fax: 857-203-5680
Mailing address:
  • Phone: 413-743-9679
  • Fax: 775-719-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1389
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: