MEDICARE: ELIZABETH BURNSIDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073126470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BURNSIDE

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 PARK RD STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6664
Country	:	US
Telephone Number	:	704-919-1280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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Directions to “ ELIZABETH BURNSIDE ” Practice Location

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