Provider Demographics
NPI:1982280806
Name:BURKHART, AMY DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DAWN
Last Name:BURKHART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 E 53RD ST S
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5309
Mailing Address - Country:US
Mailing Address - Phone:479-806-7984
Mailing Address - Fax:
Practice Address - Street 1:1001 S 41ST ST E
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-6253
Practice Address - Country:US
Practice Address - Phone:918-781-6565
Practice Address - Fax:918-683-1496
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1658208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation