Provider Demographics
NPI:1821116906
Name:SY-BUGAY, THERESA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SY-BUGAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:SY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2717 N 475 W
Mailing Address - Street 2:
Mailing Address - City:W LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9205
Mailing Address - Country:US
Mailing Address - Phone:765-583-0079
Mailing Address - Fax:
Practice Address - Street 1:2717 N 475 W
Practice Address - Street 2:
Practice Address - City:W LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-9205
Practice Address - Country:US
Practice Address - Phone:765-583-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005943A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist