Active NPI
David Burke, PTA
- Physical Therapy Assistant
- Potosi, MO
National Provider Identifier
1376896910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 116295
- Practice address
- 1 Georgian Gardens Dr
Potosi, MO 63664-1436 - Phone
- (573) 436-0691
- NPI assigned
- Oct 19, 2012
- Last updated
- Oct 19, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 116295 | MO | Primary |
Addresses
Primary practice location
1 Georgian Gardens Dr
Potosi, MO 63664-1436
Mailing address
11167 Province Rd
Irondale, MO 63648-9513
Phone (573) 749-3808
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116295 | MO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350604800000",
"number": "1376896910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11167 PROVINCE RD",
"city": "IRONDALE",
"state": "MO",
"postal_code": "636489513",
"telephone_number": "573-749-3808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GEORGIAN GARDENS DR",
"city": "POTOSI",
"state": "MO",
"postal_code": "636641436",
"telephone_number": "573-436-0691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKE",
"first_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-19",
"last_updated": "2012-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MO",
"license": "116295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potosi, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.