Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 108617852401 | UT |
NPI | 1649750621 |
---|---|
Provider Name | Nicholas Burke |
First Address | Salt Lake City, UT 84102-3678 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2018 |
Last Update Date | 03/12/2021 |