Provider Demographics
NPI:1619096591
Name:BURS, VERNISE LORRAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:VERNISE
Middle Name:LORRAINE
Last Name:BURS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 N CHARLES ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-4627
Mailing Address - Country:US
Mailing Address - Phone:410-889-7872
Mailing Address - Fax:410-889-7992
Practice Address - Street 1:2530 N CHARLES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4627
Practice Address - Country:US
Practice Address - Phone:410-889-7872
Practice Address - Fax:410-889-7992
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52676301OtherCAREFIRST BLUE CROSS
DC0001W486OtherCAREFIRST BLUE CROSS
MDKL35HT45Medicare ID - Type UnspecifiedPROVIDER