Provider Demographics
NPI:1043942881
Name:BURK, LANCE (DPT)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:BURK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40845 MERCHANTS LN
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3767
Mailing Address - Country:US
Mailing Address - Phone:240-530-8188
Mailing Address - Fax:301-638-0470
Practice Address - Street 1:40845 MERCHANTS LN
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3767
Practice Address - Country:US
Practice Address - Phone:240-530-8188
Practice Address - Fax:301-638-0470
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist