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General NPI Number Information
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NPI Number | 1366121063
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Entity Type | Individual
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Provider Name | MATTHEW GORDON BURKHALTER
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Gender | Male
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 60 COLUMBIA ST
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City | ORLANDO
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State | FL
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Zip | 32806-1115
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Country | US
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Telephone | 321-841-5744
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Fax |
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Provider Business Mailing Address
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Address Line | 60 COLUMBIA ST STE 300
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City | ORLANDO
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State | FL
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Zip | 32806-1115
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Country | US
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Telephone | 407-643-1360
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Fax | 407-635-5571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT26555
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License Number State |
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