MEDICARE: DR. MATTHEW DEREK 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	PTH6623	AL

General Provider Information

NPI Number	:	1578807616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DEREK BURKE DPT

Provider Business Mailing Address
First Line	:	2017 CANYON RD
Second Line	:	SUITE 21
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1900
Country	:	US
Telephone Number	:	205-822-8320
Fax Number	:	205-822-8323

Provider Business Practice Location Address
First Line	:	2017 CANYON RD
Second Line	:	SUITE 21
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1900
Country	:	US
Telephone Number	:	205-822-8320
Fax Number	:	205-822-8323

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	04/21/2023

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