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NPI Code Detail

MEDICARE: CONNOR BURK PT

MEDICARE: CONNOR BURK PT
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
12251X0800XOrthopedic Physical TherapistNC

General Provider Information

NPI Number : 1629687140
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR BURK PT
Provider Business Mailing Address
First Line : 18831 STATESVILLE RD
Second Line :
City : CORNELIUS
State : NC
Zip : 28031-6755
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18831 STATESVILLE RD
Second Line :
City : CORNELIUS
State : NC
Zip : 28031-6755
Country : US
Telephone Number : 704-609-0357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2020
Last Update Date : 07/30/2020

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Directions to “ CONNOR BURK PT” Practice Location

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