MEDICARE: MARK ALAN BURBA

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	:	1356927438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALAN BURBA

Provider Business Mailing Address
First Line	:	2909 RINEYVILLE BIG SPRINGS RD
Second Line	:
City	:	RINEYVILLE
State	:	KY
Zip	:	40162-9642
Country	:	US
Telephone Number	:	270-706-3185
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 RINEYVILLE BIG SPRINGS RD
Second Line	:
City	:	RINEYVILLE
State	:	KY
Zip	:	40162-9642
Country	:	US
Telephone Number	:	270-706-3185
Fax Number	:

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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Directions to “ MARK ALAN BURBA ” Practice Location

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