Provider Demographics
NPI:1457520652
Name:BURKHARD, LISA LOUISE
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOUISE
Last Name:BURKHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WHISPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7204
Mailing Address - Country:US
Mailing Address - Phone:814-404-3023
Mailing Address - Fax:
Practice Address - Street 1:200 RACHEL DR
Practice Address - Street 2:
Practice Address - City:PLEASANT GAP
Practice Address - State:PA
Practice Address - Zip Code:16823-9622
Practice Address - Country:US
Practice Address - Phone:814-506-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist