Provider Demographics
NPI:1215044474
Name:BURSCH, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BURSCH
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 1:345 COTTAGE FARM DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5971
Mailing Address - Country:US
Mailing Address - Phone:343-522-9914
Mailing Address - Fax:
Practice Address - Street 1:300 MIDTOWN DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5200
Practice Address - Country:US
Practice Address - Phone:843-521-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1288OtherLICENSE #