Provider Demographics
NPI:1750983474
Name:BURES, KATHRYN LOUISE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LOUISE
Last Name:BURES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPRUCE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3683
Mailing Address - Country:US
Mailing Address - Phone:724-454-0398
Mailing Address - Fax:
Practice Address - Street 1:905 SPRUCE ST STE 104
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3683
Practice Address - Country:US
Practice Address - Phone:724-454-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist