Provider Demographics
NPI:1023233442
Name:BURS AND GARRETT PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:BURS AND GARRETT PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERNISE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:BURS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-889-7872
Mailing Address - Street 1:3202 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4555
Mailing Address - Country:US
Mailing Address - Phone:410-889-7872
Mailing Address - Fax:410-889-7992
Practice Address - Street 1:3202 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-4555
Practice Address - Country:US
Practice Address - Phone:410-889-7872
Practice Address - Fax:410-889-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCW486OtherCAREFIRST DC
MD128158500Medicaid
MDKL35BUOtherCAREFIRST MD