Provider Demographics
NPI:1447503537
Name:BURKE, RYAN MATTHEW (DPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MATTHEW
Last Name:BURKE
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:2300 CROWN COLONY DR
Mailing Address - Street 2:STE 102
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0902
Mailing Address - Country:US
Mailing Address - Phone:617-657-5921
Mailing Address - Fax:781-986-0991
Practice Address - Street 1:110 FLORENCE STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-321-7000
Practice Address - Fax:781-322-9678
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2016-06-22
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Provider Licenses
StateLicense IDTaxonomies
MA20170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist