Provider Demographics
NPI:1366057713
Name:BURKE, CHRISTOPHER ALAN
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:BURKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 LAKE CAROLYN PKWY APT 327
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4181
Mailing Address - Country:US
Mailing Address - Phone:925-918-0433
Mailing Address - Fax:
Practice Address - Street 1:810 LAKE CAROLYN PKWY APT 327
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4181
Practice Address - Country:US
Practice Address - Phone:925-918-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist