Benjamin Robert Burke, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6177 Issued in OK

Practice address

1415 Casady LN
The Village, OK 73120-1609

Phone

(405) 318-7390

NPI assigned

Jul 25, 2022

Last updated

Aug 14, 2023By 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)

Enrolled

Practice roles

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

• Renew Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • The Village, OK
  • NPI 1063295202
  NPD Authorized official

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

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1588390330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 CASADY LN",
            "city": "THE VILLAGE",
            "state": "OK",
            "postal_code": "731201609",
            "telephone_number": "405-318-7390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 CASADY LN",
            "city": "THE VILLAGE",
            "state": "OK",
            "postal_code": "731201609",
            "telephone_number": "405-318-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "BENJAMIN",
        "middle_name": "ROBERT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-25",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "6177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yasmin Esther Avila Guillen, BACHELOR
• BH Endeavors Okc LLC (Bristol Pharmacy)
• Bragg Family Hearing Aid Center, LLC
• Jeffrey Bragg II, L.H.I.S.
• Jeffrey Bragg Sr., L.H.I.S
• Natalie Cleverdon, M.S., LMFT CANDIDATE
• Lashandra Renee' Craig
• Maya Doughan
• Braxton Kash Douthit
• Jordan Edwards, LADC-US

• Physical Therapist in The Village, OK
• Providers in The Village, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.