Provider Demographics
NPI:1699985275
Name:BURKLE, THOMAS ZACHARY (AUD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ZACHARY
Last Name:BURKLE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6923
Mailing Address - Country:US
Mailing Address - Phone:260-471-5693
Mailing Address - Fax:260-471-4942
Practice Address - Street 1:4720 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-6923
Practice Address - Country:US
Practice Address - Phone:260-471-5693
Practice Address - Fax:260-471-4942
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002551A231H00000X
KY0908231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier