Healthcare Provider Details

I. General information

NPI: 1023233442
Provider Name (Legal Business Name): BURS AND GARRETT PHYSICAL THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 FAIRVIEW RD
GWYNN OAK MD
21207-4555
US

IV. Provider business mailing address

3202 FAIRVIEW RD
GWYNN OAK MD
21207-4555
US

V. Phone/Fax

Practice location:
  • Phone: 410-889-7872
  • Fax: 410-889-7992
Mailing address:
  • Phone: 410-889-7872
  • Fax: 410-889-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: MRS. VERNISE LORRAINE BURS
Title or Position: DIRECTOR
Credential: PT
Phone: 410-889-7872