Provider Demographics
NPI:1710029004
Name:PUYEAR, CORY (PT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:PUYEAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1122
Mailing Address - Country:US
Mailing Address - Phone:630-323-2225
Mailing Address - Fax:630-323-7790
Practice Address - Street 1:780 BURR OAK DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1122
Practice Address - Country:US
Practice Address - Phone:630-323-2225
Practice Address - Fax:630-323-7790
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist