Provider Demographics
NPI:1720563216
Name:BOURKE, AOIFE
Entity type:Individual
Prefix:
First Name:AOIFE
Middle Name:
Last Name:BOURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 LEIMS DR
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-2088
Mailing Address - Country:US
Mailing Address - Phone:919-748-8795
Mailing Address - Fax:
Practice Address - Street 1:12203 LEIMS DR
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-2088
Practice Address - Country:US
Practice Address - Phone:919-748-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052137852251X0800X
CAPT2952082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic