Peregrine Joseph Burke-McAllister, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502006203 Issued in MI

Practice address

1423 W Centre Ave
Portage, MI 49024-5323

Phone

(269) 323-4300

NPI assigned

Sep 16, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120
  NPD
• Physical Therapy One, P.C.

  • Physical Therapist
  • Portage, MI
  • NPI 1962499855

  Physical Therapy Assistant

  NPD (past)

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1518573518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245323",
            "telephone_number": "269-323-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490245323",
            "telephone_number": "269-323-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE-MCALLISTER",
        "first_name": "PEREGRINE",
        "middle_name": "JOSEPH",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502006203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "OptimisPT",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PTEMR",
            "address_1": "1423 W Centre Ave",
            "city": "Portage",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490245323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Breana Buikema
• Mary Ann Bukowski, D.D.S.
• Carole Marie Bullmer, ED.D.
• Justine Elizabeth Bunka
• Cristy J Burghardt, PA-C
• Lynette Marie Burkett, AUD
• Jessica Erin Burley, RPH
• Cassandra Burlingame, LMSW
• Carrie Burnett, RN
• Alton Burns

• Physical Therapy Assistant in Portage, MI
• Providers in Portage, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.