Myra Marie Burkhardt, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3650-024 Issued in WI

Practice address

1540 Heritage Blvd
Suite 101a
West Salem, WI 54669-1417

Phone

(608) 786-4989

Fax

(608) 786-2321

NPI assigned

Aug 28, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1992813117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23477 COUNTY HIGHWAY Y",
            "city": "ROCKLAND",
            "state": "WI",
            "postal_code": "546538707",
            "telephone_number": "608-486-4090",
            "fax_number": "608-486-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 HERITAGE BLVD",
            "address_2": "SUITE 101A",
            "city": "WEST SALEM",
            "state": "WI",
            "postal_code": "546691417",
            "telephone_number": "608-786-4989",
            "fax_number": "608-786-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKHARDT",
        "first_name": "MYRA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3650-024",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5722",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI STATE PT LICENSE #",
            "identifier": "3650-024",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN STATE LICENSE #",
            "identifier": "5722",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen J Bonifas, PT
• Angela Boutin, LPN
• Amy Pat Brieske, RPH
• Jennifer Bungartz
• Burkhardt Physical Therapy Center LLC
• Hannah Lorraine Butler
• Carly Baker
• Charles W Flume DDS SC
• Alyssa Kay Chmielewski, DPT
• Melissa Joy Choi, RN

• Physical Therapist in West Salem, WI
• Providers in West Salem, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.