Doctor Name: | MATTHEW BURKS |
NPI Number: | 1013398247 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 1575 |
Business Practice Address: | 1331 Prairie Ave Suite 6 Cheyenne, WY - 820094867 |
Business Phone Number: | 3076374617 |
Business Fax Number: | |
Mailing Address: | 1331 Prairie Ave, Suite 6 CHEYENNE |
State: | WY |
Postal Code: | 820094867 |
Phone Number: | 3076374617 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2015 |
NPI Last Update Date: | 06/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 1575 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |