Provider Demographics
NPI:1861174047
Name:BURKHALTER, DAVID MICHAEL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:BURKHALTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E REYNOLDS DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2817
Mailing Address - Country:US
Mailing Address - Phone:318-680-3725
Mailing Address - Fax:
Practice Address - Street 1:304 E REYNOLDS DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2817
Practice Address - Country:US
Practice Address - Phone:318-224-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11468208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation