Provider Demographics
NPI:1114185097
Name:BURKHEAD, ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:BURKHEAD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9671
Mailing Address - Country:US
Mailing Address - Phone:502-384-6280
Mailing Address - Fax:
Practice Address - Street 1:6301 BASS RD
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9384
Practice Address - Country:US
Practice Address - Phone:502-228-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01052225200000X
IN06002334A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant