Provider Demographics
NPI:1194759522
Name:BURKE, THOMAS M (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BURKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1050 OLD DES PERES RD
Mailing Address - Street 2:SUITE 40
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1873
Mailing Address - Country:US
Mailing Address - Phone:314-821-0200
Mailing Address - Fax:314-821-9976
Practice Address - Street 1:104 JUNGERMANN RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1608
Practice Address - Country:US
Practice Address - Phone:636-926-2641
Practice Address - Fax:636-926-3385
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO107124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist