Provider Demographics
NPI:1023127065
Name:BURCHART, CORI ANN (MPT)
Entity type:Individual
Prefix:MRS
First Name:CORI
Middle Name:ANN
Last Name:BURCHART
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5522 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7105
Mailing Address - Country:US
Mailing Address - Phone:918-488-8285
Mailing Address - Fax:918-488-8144
Practice Address - Street 1:5522 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7105
Practice Address - Country:US
Practice Address - Phone:918-488-8285
Practice Address - Fax:918-488-8144
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK242416700Medicare ID - Type Unspecified
OKQ14671Medicare UPIN