Provider Demographics
NPI:1902360241
Name:BURKHART, STEPHANIE LYNNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LYNNE
Other - Last Name:OWENS-BURKHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1555 W PEARSON ST APT F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5227
Mailing Address - Country:US
Mailing Address - Phone:708-341-8532
Mailing Address - Fax:708-301-2631
Practice Address - Street 1:12251 W 159TH ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7847
Practice Address - Country:US
Practice Address - Phone:708-301-2255
Practice Address - Fax:708-301-2631
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700191842251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic