Healthcare Provider Details

I. General information

NPI: 1659440709
Provider Name (Legal Business Name): STACI BURKARD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S WHITNEY WAY STE 200
MADISON WI
53705-4656
US

IV. Provider business mailing address

340 S WHITNEY WAY STE 200
MADISON WI
53705-4656
US

V. Phone/Fax

Practice location:
  • Phone: 608-238-1312
  • Fax: 608-238-1464
Mailing address:
  • Phone: 608-238-1312
  • Fax: 608-238-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.008022
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: