Provider Demographics
NPI:1174652754
Name:BURKHOLDER, RICHARD MARK (ATC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:BURKHOLDER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GRAYPEBBLE CIR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1666
Mailing Address - Country:US
Mailing Address - Phone:856-740-0031
Mailing Address - Fax:
Practice Address - Street 1:1 NOVACARE WAY
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-5900
Practice Address - Country:US
Practice Address - Phone:215-339-5493
Practice Address - Fax:215-463-8171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000239A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer