Provider Demographics
NPI:1588052229
Name:BURGDORFF, KENNETH G (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:G
Last Name:BURGDORFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 W CORAK ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3228
Mailing Address - Country:US
Mailing Address - Phone:626-962-9702
Mailing Address - Fax:
Practice Address - Street 1:2720 NEVADA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2318
Practice Address - Country:US
Practice Address - Phone:626-443-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist