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General NPI Number Information
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NPI Number | 1982431201
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Entity Type | Individual
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Provider Name | MARY BURKE
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 2500 RIDGEWOOD RD
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-9600
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Country | US
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Telephone | 732-528-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 103 3RD AVE APT 2
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City | BRADLEY BEACH
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State | NJ
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Zip | 07720-1259
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Country | US
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Telephone |
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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 | 40QA00940500
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License Number State | NJ
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