Individual
ETHAN BURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
BENNETT, 18 GYM DR, ORONO, ME 04473
(207) 450-4095
Mailing address
18 BOWER ST, BANGOR, ME 04401-4722
(207) 450-4095
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT962
ME
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/10/2021
Last updated
01/21/2025
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