Provider Demographics
NPI:1669350906
Name:BURRIS, LAKEN LASHELLE
Entity type:Individual
Prefix:
First Name:LAKEN
Middle Name:LASHELLE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 TOTEROS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6950
Mailing Address - Country:US
Mailing Address - Phone:704-618-2300
Mailing Address - Fax:704-843-9045
Practice Address - Street 1:1229 TOTEROS DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6950
Practice Address - Country:US
Practice Address - Phone:704-618-2300
Practice Address - Fax:704-843-9045
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP24397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist