MEDICARE: WILLIAM JON BURKE 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
1	225100000X	Physical Therapist	11052	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710058482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JON BURKE PT

Provider Business Mailing Address
First Line	:	11177 LAMBS LN
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-9779
Country	:	US
Telephone Number	:	740-763-0408
Fax Number	:	740-763-0485

Provider Business Practice Location Address
First Line	:	812 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1947
Country	:	US
Telephone Number	:	740-392-8811
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	05/13/2008

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