Provider Demographics
NPI:1538812524
Name:BURK, JENNIFER M (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BURK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 POLAND MNR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2010
Mailing Address - Country:US
Mailing Address - Phone:330-757-1815
Mailing Address - Fax:
Practice Address - Street 1:33 POLAND MNR
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2010
Practice Address - Country:US
Practice Address - Phone:330-757-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011085L225100000X
OHPT-5923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist