Shawn Lee Burke, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-097 Issued in ID

Practice address

827 W Prairie Ave
Hayden, ID 83835-8459

Phone

(208) 660-9378

NPI assigned

Dec 9, 2019

Last updated

Dec 9, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1154968139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 N HARLEQUIN DR",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838547573",
            "telephone_number": "208-660-9378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 W PRAIRIE AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358459",
            "telephone_number": "208-660-9378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "SHAWN",
        "middle_name": "LEE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-09",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "PTA-097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson Batterson Brown, DC
• Jennie Rose Brown, PHARMD
• Tyrel J Bruneel, OD
• Mark Dana Bullock, PH.D.
• Laura K. Burgeson, PA-C
• Daryll Butler, RPH
• Scout Moon-Shun Cai, DPT
• Bethany Ann Camarata, LCSW CCTP
• Julianne Jean Cameron, DO
• Cre'Elle Olivia Campa, LPC

• Physical Therapy Assistant in Hayden, ID
• Providers in Hayden, ID by specialty
• Physical Therapy Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.