Provider Demographics
NPI:1770770471
Name:BURY, JOANNE (PT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:BURY
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 1:1593 NW SPRUCE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9525
Mailing Address - Country:US
Mailing Address - Phone:772-692-1601
Mailing Address - Fax:
Practice Address - Street 1:1593 NW SPRUCE RIDGE DR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9525
Practice Address - Country:US
Practice Address - Phone:772-692-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0000870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY1736Medicare PIN
FLX0039Medicare PIN