Provider Demographics
NPI:1952026551
Name:BURNS, MADELINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 PATAPSCO ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4232
Mailing Address - Country:US
Mailing Address - Phone:443-928-6683
Mailing Address - Fax:
Practice Address - Street 1:3104 LORD BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2898
Practice Address - Country:US
Practice Address - Phone:443-516-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD28258OtherMARYLAND STATE BOARD OF PHYSICAL THERAPY EXAMINERS