Healthcare Provider Details

I. General information

NPI: 1811236201
Provider Name (Legal Business Name): PATRICIA BURKEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 6TH AVE
HUNTINGTON WV
25701-2308
US

IV. Provider business mailing address

1018 6TH AVE
HUNTINGTON WV
25701-2308
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1155
  • Fax:
Mailing address:
  • Phone: 304-522-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2011-2841
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: