Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1389 | MA |
NPI | 1821002635 |
---|---|
Provider Name | Mr. Robert Joseph Burke |
First Address | Adams, MA 01220-1541 |
Second Address | West Roxbury, MA 02132-4927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |