Provider Demographics
NPI:1689128696
Name:BURKHART, JANET GRACE (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:GRACE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 EWALD AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3410
Mailing Address - Country:US
Mailing Address - Phone:971-218-0772
Mailing Address - Fax:503-540-7330
Practice Address - Street 1:910 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1201
Practice Address - Country:US
Practice Address - Phone:971-218-0772
Practice Address - Fax:503-540-7330
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21642225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist