Provider Demographics
NPI:1235434259
Name:BURGENER, TODD JACOB (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:JACOB
Last Name:BURGENER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 PIEDMONT AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1326
Mailing Address - Country:US
Mailing Address - Phone:801-372-1652
Mailing Address - Fax:
Practice Address - Street 1:2741 PIEDMONT AVE APT 10
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1326
Practice Address - Country:US
Practice Address - Phone:801-372-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist