1386034445 NPI number — BURKE COLLINS THERAPY, INC.

Table of content: (NPI 1386034445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386034445 NPI number — BURKE COLLINS THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURKE COLLINS THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386034445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33601-3147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-253-3092
Provider Business Mailing Address Fax Number:
813-259-9516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5968 CLARK CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34238-2715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-253-3092
Provider Business Practice Location Address Fax Number:
813-259-9516
Provider Enumeration Date:
01/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
CARLETON
Authorized Official Middle Name:
BURKE
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
813-253-3092

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  68-6650 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RT1 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 68-6650 . This is a "OUTPATIENT REHABILITATION FACILITY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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