Active NPI
Lisa Marie Burdick, PTA
- Physical Therapy Assistant
- Freeport, ME
National Provider Identifier
1063481653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PA2433
- Practice address
- 45 Mallett Dr
Freeport, ME 04032-1312 - Phone
- (207) 442-0325
- Fax
- (207) 443-4578
- NPI assigned
- Mar 16, 2006
- Last updated
- Feb 22, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PA2433 | ME | Primary |
Addresses
Primary practice location
45 Mallett Dr
Freeport, ME 04032-1312
Mailing address
45 Mallett Dr
Freeport, ME 04032-1312
Phone (207) 442-0325
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431972299 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2433 | ME | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329868800000",
"number": "1063481653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 MALLETT DR",
"city": "FREEPORT",
"state": "ME",
"postal_code": "040321312",
"telephone_number": "207-442-0325",
"fax_number": "207-443-4578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 MALLETT DR",
"city": "FREEPORT",
"state": "ME",
"postal_code": "040321312",
"telephone_number": "207-442-0325",
"fax_number": "207-443-4578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURDICK",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-16",
"last_updated": "2012-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ME",
"license": "PA2433",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "431972299",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Freeport, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.