Provider Demographics
NPI:1699763425
Name:BURKE, CHRISTINE MARY (PT PHYSICAL THERAPIS)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARY
Last Name:BURKE
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MAHAFFY RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-3021
Mailing Address - Country:US
Mailing Address - Phone:518-692-1175
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-1343
Practice Address - Country:US
Practice Address - Phone:518-692-3311
Practice Address - Fax:518-692-8153
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010790-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10074428OtherCDPHP
NY394885OtherMVP
NY77028OtherGHI (HMO)
NYQQ9211OtherEMPIRE BC/BS
NY7652477OtherAETNA
NY0004039920001OtherCOMMUNITY BLUE
NY6697957OtherGHI (PPO)
NY10074428OtherCDPHP
NY77028OtherGHI (HMO)