Individual
CONNOR JAY BURKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
862 MARTINGALE LN, PARK CITY, UT 84098-7571
(310) 560-2946
Mailing address
862 MARTINGALE LN, PARK CITY, UT 84098-7571
(310) 560-2946
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-329528
UT
Other
Enumeration date
06/10/2024
Last updated
06/10/2024
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