NPIMap

Organization Active NPI

Burkhardt Physical Therapy Center LLC

  • Physical Therapist
  • West Salem, WI
National Provider Identifier
1710163878
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3650024 Issued in WI
Legal business name
BURKHARDT PHYSICAL THERAPY CENTER LLC
Practice address
1540 Heritage Blvd Ste 101a
West Salem, WI 54669-1418
Phone
(608) 786-4989
NPI assigned
Jan 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randy W Burkhardt
Title
Member, Manager
Phone
(608) 786-4989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 3650024 WI Primary

Addresses

Primary practice location

1540 Heritage Blvd Ste 101a
West Salem, WI 54669-1418

Mailing address

1540 Heritage Blvd Ste 101a
West Salem, WI 54669-1418
Phone (608) 786-4989

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080222000068 WI Part B Supplier - Clinic/Group Practice 1557445061 Receives reassigned benefits from 7 practitioners
Practice locations: West Salem, WI

National Provider Directory

National Provider Directory

Locations

1540 Heritage Blvd
Ste 101A
West Salem, WI 54669
Phone (608) 786-4989

1555 Heritage Blvd
West Salem, WI 54669
Phone (608) 786-4989

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200614400000",
    "number": "1710163878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 HERITAGE BLVD STE 101A",
            "city": "WEST SALEM",
            "state": "WI",
            "postal_code": "546691418",
            "telephone_number": "608-786-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 HERITAGE BLVD STE 101A",
            "city": "WEST SALEM",
            "state": "WI",
            "postal_code": "546691418",
            "telephone_number": "608-786-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURKHARDT PHYSICAL THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-18",
        "last_updated": "2008-01-18",
        "status": "A",
        "authorized_official_last_name": "BURKHARDT",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEMBER, MANAGER",
        "authorized_official_telephone_number": "608-786-4989"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3650024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Salem, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.