Healthcare Provider Details

I. General information

NPI: 1245319581
Provider Name (Legal Business Name): CARRIE BURGERT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W LOS ANGELES AVE STE 110
MOORPARK CA
93021-1898
US

IV. Provider business mailing address

144 W LOS ANGELES AVE STE 110
MOORPARK CA
93021-1898
US

V. Phone/Fax

Practice location:
  • Phone: 805-552-1915
  • Fax: 805-552-1991
Mailing address:
  • Phone: 805-552-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT29733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: