Basic Information
| Provider Information | |||||||||
| NPI: | 1821002635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RKT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 N SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | ADAMS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012201541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137439679 | ||||||||
| FaxNumber: | 7757192346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 VFW PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021324927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173237700 | ||||||||
| FaxNumber: | 8572035680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 226300000X | 1389 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Kinesiotherapist |
No ID Information.