MEDICARE: MRS. CORI ANN BURCHART M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT3623	OK

General Provider Information

NPI Number	:	1023127065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORI ANN BURCHART M.P.T.

Provider Business Mailing Address
First Line	:	5522 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7105
Country	:	US
Telephone Number	:	918-488-8285
Fax Number	:	918-488-8144

Provider Business Practice Location Address
First Line	:	5522 S LEWIS AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-7105
Country	:	US
Telephone Number	:	918-488-8285
Fax Number	:	918-488-8144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/03/2016

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