Provider Demographics
NPI:1083865588
Name:BURGCHARDT, KURT REYNOLDS (PT)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:REYNOLDS
Last Name:BURGCHARDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 HARTNELL ST
Mailing Address - Street 2:SUITE #200 A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2833
Mailing Address - Country:US
Mailing Address - Phone:831-655-4024
Mailing Address - Fax:
Practice Address - Street 1:576 HARTNELL ST
Practice Address - Street 2:SUITE #200 A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2833
Practice Address - Country:US
Practice Address - Phone:831-655-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist