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NPI Code Detail

MEDICARE: MR. JOHN C. BURKHOLDER PHYSICAL THERAPIST

MEDICARE: MR. JOHN C. BURKHOLDER PHYSICAL THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1129120TX

General Provider Information

NPI Number : 1417972043
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN C. BURKHOLDER PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 14241 NORTHWEST BLVD
Second Line : STE 101
City : CORPUS CHRISTI
State : TX
Zip : 78410-5545
Country : US
Telephone Number : 361-664-9675
Fax Number : 361-664-1100
Provider Business Practice Location Address
First Line : 4040 FIVE POINTS RD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78410-4538
Country : US
Telephone Number : 361-241-7399
Fax Number : 361-241-7464
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 02/23/2021

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