Healthcare Provider Details

I. General information

NPI: 1780469189
Provider Name (Legal Business Name): MICHAEL BURGESS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 SAND HILL RD STE 101
CANDLER NC
28715-0470
US

IV. Provider business mailing address

408 HIGUERA ST STE 200
SAN LUIS OBISPO CA
93401-6135
US

V. Phone/Fax

Practice location:
  • Phone: 828-552-5342
  • Fax: 828-641-9303
Mailing address:
  • Phone: 805-788-0805
  • Fax: 805-788-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22602
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12552PT
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP052045T
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: