Provider Demographics
NPI:1316216591
Name:BURKHALTER, TERRELL LYNN (PTA)
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:LYNN
Last Name:BURKHALTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 RATON AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-3424
Mailing Address - Country:US
Mailing Address - Phone:719-469-6573
Mailing Address - Fax:
Practice Address - Street 1:317 W 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1401
Practice Address - Country:US
Practice Address - Phone:719-383-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant