Provider Demographics
NPI:1982824892
Name:BURES, BETH ANNE (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:BURES
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 1:2940 N SHEFFIELD AVE
Mailing Address - Street 2:APT 4N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7086
Mailing Address - Country:US
Mailing Address - Phone:617-842-1378
Mailing Address - Fax:
Practice Address - Street 1:5052 WATERFORD DR
Practice Address - Street 2:UNIT 102
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1497
Practice Address - Country:US
Practice Address - Phone:440-934-9950
Practice Address - Fax:440-934-9952
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist