Healthcare Provider Details

I. General information

NPI: 1043661663
Provider Name (Legal Business Name): KAITLYN BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 FOLLY RD STE B
CHARLESTON SC
29412-3938
US

IV. Provider business mailing address

930 FOLLY RD STE B
CHARLESTON SC
29412-3938
US

V. Phone/Fax

Practice location:
  • Phone: 843-314-5432
  • Fax: 843-277-6237
Mailing address:
  • Phone: 843-314-5432
  • Fax: 843-277-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8185
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: