Provider Demographics
NPI:1972559623
Name:MURRAY, DAVID BRUCE (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:MURRAY
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:3112 OCOEE ST N
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5382
Practice Address - Country:US
Practice Address - Phone:423-559-1537
Practice Address - Fax:423-559-1539
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000976027CMedicaid
TN03650060Medicaid
TN0446652Medicaid
TN3156797OtherBCBST
TN5441648Medicaid
GA000976027AMedicaid
TN3654493Medicaid
GA000976027BMedicaid
GA52808161001OtherBCBS GA
TN5441648Medicaid
TN3156797OtherBCBST
GA65BBXRMedicare ID - Type Unspecified
TN3654493Medicaid
TN3650060Medicare PIN
TN103I654889Medicare PIN
GA65BBBXRMedicare PIN