Provider Demographics
NPI:1588123202
Name:BURKE THERAPY AND WELLNESS
Entity type:Organization
Organization Name:BURKE THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:850-766-4362
Mailing Address - Street 1:3425 LAKE CENTER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2345
Mailing Address - Country:US
Mailing Address - Phone:352-729-6919
Mailing Address - Fax:352-729-6972
Practice Address - Street 1:3425 LAKE CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2345
Practice Address - Country:US
Practice Address - Phone:352-729-6919
Practice Address - Fax:352-729-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy