Provider Demographics
NPI:1376766147
Name:ABBOTT & BURKHART THERAPY
Entity Type:Organization
Organization Name:ABBOTT & BURKHART THERAPY
Other - Org Name:MELINDA BURKHART & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:805-236-2694
Mailing Address - Street 1:1601 EASTMAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6481
Mailing Address - Country:US
Mailing Address - Phone:805-650-6290
Mailing Address - Fax:805-650-6912
Practice Address - Street 1:1601 EASTMAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6481
Practice Address - Country:US
Practice Address - Phone:805-650-6290
Practice Address - Fax:805-650-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9807261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation