Healthcare Provider Details

I. General information

NPI: 1962312439
Provider Name (Legal Business Name): NICHOLAS DON BURCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 KENNEDY DR STE B
MARTIN TN
38237-3310
US

IV. Provider business mailing address

6271 FIRWOOD RD
MENTOR OH
44060-2937
US

V. Phone/Fax

Practice location:
  • Phone: 731-588-3480
  • Fax:
Mailing address:
  • Phone: 440-591-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: