Provider Demographics
NPI:1043948615
Name:BURKHARDT, ZACHARIAH JAMES (ATC)
Entity Type:Individual
Prefix:MR
First Name:ZACHARIAH
Middle Name:JAMES
Last Name:BURKHARDT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8827 WOODFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1046
Mailing Address - Country:US
Mailing Address - Phone:941-875-3361
Mailing Address - Fax:
Practice Address - Street 1:1 PIRATE PL
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-1646
Practice Address - Country:US
Practice Address - Phone:941-875-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002913A2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine