MEDICARE: MR. LAWRENCE ALLEN BUREN PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	002157	KY

General Provider Information

NPI Number	:	1427194117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE ALLEN BUREN PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	10611 STONEBREAKER RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4027
Country	:	US
Telephone Number	:	502-541-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	10611 STONEBREAKER RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4027
Country	:	US
Telephone Number	:	502-541-1716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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