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Individual

CARRIE BURGERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT

Contact information

Practice address
144 W LOS ANGELES AVE, STE 110, MOORPARK, CA 93021-1898
(805) 552-1915
(805) 552-1991
Mailing address
144 W LOS ANGELES AVE, STE 110, MOORPARK, CA 93021-1898
(805) 552-1915

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT29733
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
264440100
DEPT OF LABOR
CA
01
OPT297330
BLUE SHIELD INDIVIDUAL
CA
01
ZZZ082282
BLUE SHIELD
CA
Enumeration date
11/06/2006
Last updated
07/09/2013
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