Provider Demographics
NPI:1245548585
Name:BURKE, SANDY DIANNE (RMT)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:DIANNE
Last Name:BURKE
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10309 ZUNI ST
Mailing Address - Street 2:APT G202
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6159
Mailing Address - Country:US
Mailing Address - Phone:303-803-7264
Mailing Address - Fax:
Practice Address - Street 1:10309 ZUNI ST
Practice Address - Street 2:APT G202
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-6159
Practice Address - Country:US
Practice Address - Phone:303-803-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10944225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist