Provider Demographics
NPI:1356927438
Name:BURBA, MARK ALAN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BURBA
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 1:2909 RINEYVILLE BIG SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:RINEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40162-9642
Mailing Address - Country:US
Mailing Address - Phone:270-706-3185
Mailing Address - Fax:
Practice Address - Street 1:2909 RINEYVILLE BIG SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RINEYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40162-9642
Practice Address - Country:US
Practice Address - Phone:270-706-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty