Provider Demographics
NPI:1649444241
Name:BURQUIST, LORRAINE (PTA)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BURQUIST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:BURQUIST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:16 WEST JONES STREET
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 W JONES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1030
Practice Address - Country:US
Practice Address - Phone:919-733-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant