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General NPI Number Information
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NPI Number | 1043244478
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Entity Type | Individual
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Provider Name | BONNIE JOYCE BURKE PT, MTC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 605 OLD BALLAS RD STE 128
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7070
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Country | US
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Telephone | 314-801-8776
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Fax | 314-801-8775
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Provider Business Mailing Address
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Address Line | 605 OLD BALLAS RD STE 128
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7070
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Country | US
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Telephone | 314-801-8776
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Fax | 314-801-8775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070002879
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License Number State | IL
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