Provider Demographics
NPI:1073622734
Name:BURKHARDT, RHEENA NIETO (DPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:RHEENA
Middle Name:NIETO
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6356
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-6356
Mailing Address - Country:US
Mailing Address - Phone:949-553-8853
Mailing Address - Fax:949-553-8883
Practice Address - Street 1:1124 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6760
Practice Address - Country:US
Practice Address - Phone:949-553-8853
Practice Address - Fax:949-553-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24551Medicare ID - Type Unspecified