Provider Demographics
NPI:1801093802
Name:BURSON, MONICA C (PT)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:C
Last Name:BURSON
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 1:101 WEST COLLEGE STREET
Mailing Address - Street 2:STE. C
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051
Mailing Address - Country:US
Mailing Address - Phone:205-259-3991
Mailing Address - Fax:205-621-2212
Practice Address - Street 1:101 WEST COLLEGE STREET
Practice Address - Street 2:STE. C
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051
Practice Address - Country:US
Practice Address - Phone:205-259-3991
Practice Address - Fax:205-621-2212
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51512695OtherBCBS
ALPTH529OtherPT LICENSE
AL051512695Medicare ID - Type UnspecifiedMEDICARE PROVIDER #