Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 391941 | OH |
NPI | 1821421140 |
---|---|
Provider Name | Mr. Michael Julian Burke |
First Address | Elyria, OH 44035-4418 |
Second Address | Elyria, OH 44035-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2013 |
Last Update Date | 11/08/2013 |