Nathan T Burks, DPT

Individual provider Active NPI Physical Therapist · Palm Coast, FL

NPI 1114213832 · NPPES record last updated Oct 17, 2014

Key facts

NPI
1114213832
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
PT 29626 (FL)
Practice address
70 Town CT
Palm Coast, FL 32164-2540
Phone
(386) 597-7962
Fax
(866) 929-6036
NPI assigned
Jun 21, 2011
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
PT 29626FLMDPhysical Therapist
8967TNMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 29626 FL Yes

Addresses

Primary practice location

70 Town CT
Palm Coast, FL 32164-2540

Mailing address

PO Box 1975
Rome, GA 30162-1975
Phone (386) 597-7962

Other providers in Palm Coast, FL

All providers in Palm Coast, FL · Physical Therapist in Florida

Sources for this page

Verify at the official NPI Registry.