Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Christopher Burg

Individual provider Physical Therapist · NPI 1104604305

Jack Christopher Burg is a Physical Therapist in Private Practice in Sylvania, Ohio. Qualified in 2022, 4 years ago. Practices with Benchmark Physical Therapy Michigan LLC, a 24-clinician group and accepts Medicare assignment. Licensed in Michigan and Ohio.

Years since qualifying
4
Licensed in
MI, OH
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

5577 Monroe St Ste A1
Sylvania, OH 43560-2565
Phone: (419) 318-8104
Fax: (419) 540-9067
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT020177 (OH)
Physical Therapist Taxonomy 225100000X · Licence 5501302987 (MI)

Record details

NPI number1104604305
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 19, 2023
Last updated in NPPESAugust 6, 2026
Certification dateAugust 6, 2026
Mailing address2122 York Rd Ste 300, Oak Brook, IL 60523-1925

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Benchmark Physical Therapy Michigan Llc — 24 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Sylvania