Provider Demographics
NPI:1063536530
Name:BURKETT, AARON L (PT, DPT, MTC)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:L
Last Name:BURKETT
Suffix:
Gender:M
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GIBSON STREET
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3340
Mailing Address - Country:US
Mailing Address - Phone:419-447-3075
Mailing Address - Fax:
Practice Address - Street 1:918 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1720
Practice Address - Country:US
Practice Address - Phone:419-675-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-62452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic