MEDICARE: DR. MACKENZIE BURK

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	2255A2300X	Athletic Trainer
2	2251P0200X	Pediatric Physical Therapist	PTL.0017790	CO

General Provider Information

NPI Number	:	1972004885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MACKENZIE BURK

Provider Business Mailing Address
First Line	:	14651 DALLAS PKWY STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8856
Country	:	US
Telephone Number	:	952-715-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	13132 E 101ST PL
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-9144
Country	:	US
Telephone Number	:	952-715-1875
Fax Number	:

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

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	08/26/2022

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Directions to “ DR. MACKENZIE BURK ” Practice Location

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