MEDICARE: DR. DANIEL BURKE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT019302	OH

General Provider Information

NPI Number	:	1124696950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL BURKE DPT

Provider Business Mailing Address
First Line	:	1069 KLOTZ RD STE A
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-4832
Country	:	US
Telephone Number	:	419-728-0110
Fax Number	:	419-728-0113

Provider Business Practice Location Address
First Line	:	1069 KLOTZ RD STE A
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-4832
Country	:	US
Telephone Number	:	419-728-0110
Fax Number	:	419-728-0113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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