Healthcare Provider Details

I. General information

NPI: 1043942881
Provider Name (Legal Business Name): LANCE BURK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINDSEY LN STE A
SAINT MARYS GA
31558-1727
US

IV. Provider business mailing address

40845 MERCHANTS LN
LEONARDTOWN MD
20650-3767
US

V. Phone/Fax

Practice location:
  • Phone: 912-729-5259
  • Fax:
Mailing address:
  • Phone: 240-530-8188
  • Fax: 301-638-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051435T
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017453
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29081
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: