Healthcare Provider Details

I. General information

NPI: 1790895480
Provider Name (Legal Business Name): PAMELA L BEURY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CYPRESS STATION DR
LOUISVILLE KY
40207-5142
US

IV. Provider business mailing address

2700 STANLEY GAULT PKWY STE 129
LOUISVILLE KY
40223-5176
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-6579
  • Fax: 502-897-2725
Mailing address:
  • Phone: 502-253-4914
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003644
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003644
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: