Healthcare Provider Details

I. General information

NPI: 1134050800
Provider Name (Legal Business Name): MASON BUREN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 HAMMONDS LN
BROOKLYN PARK MD
21225-3351
US

IV. Provider business mailing address

5405 KILLINUR DR
PROSPECT KY
40059-9555
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-3400
  • Fax:
Mailing address:
  • Phone: 502-526-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058062T
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: