Provider Demographics
NPI:1710163878
Name:BURKHARDT PHYSICAL THERAPY CENTER LLC
Entity Type:Organization
Organization Name:BURKHARDT PHYSICAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-786-4989
Mailing Address - Street 1:1540 HERITAGE BLVD STE 101A
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-1418
Mailing Address - Country:US
Mailing Address - Phone:608-786-4989
Mailing Address - Fax:
Practice Address - Street 1:1540 HERITAGE BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1418
Practice Address - Country:US
Practice Address - Phone:608-786-4989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3650024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty