Provider Demographics
NPI:1194843755
Name:BURKHART, LAURA ALLISON (DPT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ALLISON
Last Name:BURKHART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6187 NOLLAR RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10484 CITATION DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6565
Practice Address - Country:US
Practice Address - Phone:810-225-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist