Provider Demographics
NPI:1942273172
Name:BURKAM, AMY LEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEIGH
Last Name:BURKAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 RIDGE VIEW PL
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7531
Mailing Address - Country:US
Mailing Address - Phone:614-430-0048
Mailing Address - Fax:614-791-0702
Practice Address - Street 1:3967 PRESIDENTIAL PARKWAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:614-791-0700
Practice Address - Fax:614-791-0702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-6444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist