Provider Demographics
NPI:1558576744
Name:SUNBURY, KATHY MAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MAY
Last Name:SUNBURY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-1428
Mailing Address - Country:US
Mailing Address - Phone:812-524-8331
Mailing Address - Fax:812-524-8331
Practice Address - Street 1:834 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-1428
Practice Address - Country:US
Practice Address - Phone:812-524-8331
Practice Address - Fax:812-524-8331
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005379A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2007097000AMedicaid