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: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W LOS ANGELES AVE STE 110
MOORPARK CA
93021-4218
US

IV. Provider business mailing address

144 W LOS ANGELES AVE STE 110
MOORPARK CA
93021-4218
US

V. Phone/Fax

Practice location:
  • Phone: 805-372-0020
  • Fax: 805-380-2470
Mailing address:
  • Phone: 805-372-0020
  • Fax: 805-380-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: