Basic Information
| Provider Information | |||||||||
| NPI: | 1437132834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKHALTER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MULHARE | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8 JOHN WALSH BLVD STE 406A | ||||||||
| Address2: | |||||||||
| City: | PEEKSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105665333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146319020 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8 JOHN WALSH BLVD STE 406A | ||||||||
| Address2: | |||||||||
| City: | PEEKSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105665333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146319020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT013131L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 174400000X | 013953-1 | NY | Y | Other Service Providers | Specialist |
No ID Information.