Provider Demographics
NPI:1639429772
Name:BURNS, BARBARA LAUREN (MPT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LAUREN
Last Name:BURNS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 BROADWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5743
Mailing Address - Country:US
Mailing Address - Phone:210-832-5400
Mailing Address - Fax:210-832-5421
Practice Address - Street 1:5307 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-832-5400
Practice Address - Fax:210-832-5400
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11693872251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01234409OtherRR MEDICARE
TX327120701Medicaid
TX12568660OtherCAQH
TX879T59OtherBCBS
TX299644YTUHMedicare PIN