Provider Demographics
NPI:1619134848
Name:BURKE, JAMES DANIEL (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:BURKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CREEKSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:SOUR LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77659-9799
Mailing Address - Country:US
Mailing Address - Phone:409-347-8585
Mailing Address - Fax:409-750-7772
Practice Address - Street 1:4025 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7146
Practice Address - Country:US
Practice Address - Phone:409-347-8585
Practice Address - Fax:409-750-7772
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist