Basic Information
| Provider Information | |||||||||
| NPI: | 1700266772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | BRAC'EE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 LONG PRAIRIE RD | ||||||||
| Address2: | 104 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750224217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727242400 | ||||||||
| FaxNumber: | 9727242495 | ||||||||
| Practice Location | |||||||||
| Address1: | 413 W BETHEL RD | ||||||||
| Address2: | 400 | ||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750194473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723049100 | ||||||||
| FaxNumber: | 9723049048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1258489 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.