=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043942881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LANCE BURK DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2022
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 LINDSEY LN STE A
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31558-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-729-5259
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40845 MERCHANTS LN
-----------------------------------------------------
City | LEONARDTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20650-3767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-530-8188
-----------------------------------------------------
Fax | 301-638-0470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | CP051435T
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT017453
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 29081
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------