Healthcare Provider Details

I. General information

NPI: 1255235032
Provider Name (Legal Business Name): CHASE BURKART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 SE BALBOA AVE
STUART FL
34994-2351
US

IV. Provider business mailing address

416 SE BALBOA AVE
STUART FL
34994-2351
US

V. Phone/Fax

Practice location:
  • Phone: 772-780-3442
  • Fax:
Mailing address:
  • Phone: 772-780-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS2034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: