Healthcare Provider Details

I. General information

NPI: 1750467767
Provider Name (Legal Business Name): JAMES W BURKE JR. MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DAVIS STUART ROAD
RONCEVERTE WV
24970
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-2184
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-3987
  • Fax: 304-647-3990
Mailing address:
  • Phone: 304-647-3987
  • Fax: 304-647-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT001724
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: