Healthcare Provider Details

I. General information

NPI: 1235562950
Provider Name (Legal Business Name): RYAN A BURKE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 FRENCHTOWN RD
N KINGSTOWN RI
02852-1758
US

IV. Provider business mailing address

52 FRENCHTOWN RD
N KINGSTOWN RI
02852-1758
US

V. Phone/Fax

Practice location:
  • Phone: 401-519-5222
  • Fax: 401-519-5222
Mailing address:
  • Phone: 401-519-5222
  • Fax: 401-519-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT02601
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: