Provider Demographics
NPI:1447215116
Name:BURCH PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BURCH PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, OCS, SCS
Authorized Official - Phone:530-226-9242
Mailing Address - Street 1:320 HARTNELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1846
Mailing Address - Country:US
Mailing Address - Phone:530-226-9242
Mailing Address - Fax:530-226-9070
Practice Address - Street 1:320 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1846
Practice Address - Country:US
Practice Address - Phone:530-226-9242
Practice Address - Fax:530-226-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0109980Medicaid
0PT188780Medicare PIN
0PT186050Medicare PIN
0PT222640Medicare PIN
CAZZZ23129ZMedicare ID - Type Unspecified
0PT113580Medicare PIN