Provider Demographics
NPI:1386629319
Name:BURKE, MATTHEW T (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:BURKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4854
Mailing Address - Country:US
Mailing Address - Phone:304-232-3617
Mailing Address - Fax:
Practice Address - Street 1:50 E WYLIE AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2002
Practice Address - Country:US
Practice Address - Phone:724-229-2901
Practice Address - Fax:724-229-7903
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist