Healthcare Provider Details

I. General information

NPI: 1154419216
Provider Name (Legal Business Name): JOHN EDWIN BURK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ROUTE 55 SUITE 101
LAGRANGEVILLE NY
12540-5017
US

IV. Provider business mailing address

30 FOREST VALLEY RD
PLEASANT VALLEY NY
12569-7609
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-2423
  • Fax: 845-471-2776
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number016283 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: