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General NPI Number Information
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NPI Number | 1225517543
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Entity Type | Individual
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Provider Name | JUSTIN BURKE
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 28620 N EL MIRAGE RD STE B102
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City | PEORIA
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State | AZ
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Zip | 85383-2098
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Country | US
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Telephone | 888-433-7993
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Fax |
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Provider Business Mailing Address
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Address Line | 15 APEX DR
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City | HIGHLAND
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State | IL
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Zip | 62249-1282
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Country | US
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Telephone | 618-651-0444
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Fax |
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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 | 1307189
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License Number State | TX
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