Provider Demographics
NPI:1659352565
Name:BURKARD, ERIC THOMAS (MA, ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:BURKARD
Suffix:
Gender:M
Credentials:MA, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 THUNDER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9295
Mailing Address - Country:US
Mailing Address - Phone:815-953-3264
Mailing Address - Fax:
Practice Address - Street 1:875 PENNSYLVANIA AVE STE A
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2529
Practice Address - Country:US
Practice Address - Phone:502-349-6961
Practice Address - Fax:502-348-1789
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096-0011242255A2300X
KYAT4372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer