Provider Demographics
NPI:1770556904
Name:BURKAM, GARRETT LEE SR (PT, DPT, SCS)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:LEE
Last Name:BURKAM
Suffix:SR
Gender:M
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 RIDGE VIEW PL
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7531
Mailing Address - Country:US
Mailing Address - Phone:614-430-0048
Mailing Address - Fax:614-791-0702
Practice Address - Street 1:3967 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7268
Practice Address - Country:US
Practice Address - Phone:614-791-0700
Practice Address - Fax:614-791-0702
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-64112251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBU4181281Medicare PIN