Provider Demographics
NPI:1770665325
Name:BURLINGAME PHYSIOTHERAPY, LLC
Entity Type:Organization
Organization Name:BURLINGAME PHYSIOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURLINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:720-482-0071
Mailing Address - Street 1:6041 S SYRACUSE WAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4771
Mailing Address - Country:US
Mailing Address - Phone:720-482-0071
Mailing Address - Fax:720-482-0081
Practice Address - Street 1:6041 S SYRACUSE WAY
Practice Address - Street 2:SUITE 307
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4771
Practice Address - Country:US
Practice Address - Phone:720-482-0071
Practice Address - Fax:720-482-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COBU667610OtherB/C AND B/S PROVIDER ID
COBU667610OtherB/C AND B/S PROVIDER ID