Provider Demographics
NPI:1164695300
Name:BURGDORF, DARYN (PT)
Entity Type:Individual
Prefix:MR
First Name:DARYN
Middle Name:
Last Name:BURGDORF
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 1:7 OLDE COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1688
Mailing Address - Country:US
Mailing Address - Phone:828-301-7156
Mailing Address - Fax:
Practice Address - Street 1:75 LEROY GEORGE DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7461
Practice Address - Country:US
Practice Address - Phone:828-452-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist