Provider Demographics
NPI:1912558925
Name:PURYEAR, BIANCA M (PTA)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:M
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8071 IRENE BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3836
Mailing Address - Country:US
Mailing Address - Phone:901-600-7186
Mailing Address - Fax:
Practice Address - Street 1:7820 WALKING HORSE CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2143
Practice Address - Country:US
Practice Address - Phone:901-752-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7219208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation