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General NPI Number Information
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NPI Number | 1316190200
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Entity Type | Individual
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Provider Name | MARGARET MARY BOURKE PTA
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Gender | Female
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 6801 HIGH GROVE BLVD
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City | BURR RIDGE
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State | IL
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Zip | 60527-7585
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Country | US
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Telephone | 630-734-4588
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Fax |
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Provider Business Mailing Address
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Address Line | 139 N LINDEN AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1709
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Country | US
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Telephone | 630-241-2808
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.000194
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License Number State | IL
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