Provider Demographics
NPI:1154450245
Name:BURKHART, LAURIE ANN (MPT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:BURKHART
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:JUERGENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3130 SYLVAN DR W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-565-3450
Mailing Address - Fax:
Practice Address - Street 1:3130 SYLVAN DR W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-565-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPO6759OtherREGENCE
WA108997OtherL&I NUMBER
WAPO6759OtherREGENCE