Provider Demographics
NPI:1922296383
Name:BURNS-SMITH, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BURNS-SMITH
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 1:19201 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5027
Mailing Address - Country:US
Mailing Address - Phone:301-948-2414
Mailing Address - Fax:301-948-0597
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 125
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-0232
Practice Address - Fax:301-774-7885
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00031OtherMEDICARE GROUP
000B28R31Medicare PIN