Provider Demographics
NPI:1679799704
Name:BURBARY, SCOTT ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALAN
Last Name:BURBARY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7795 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4193
Mailing Address - Country:US
Mailing Address - Phone:248-939-7775
Mailing Address - Fax:
Practice Address - Street 1:7508 M E CAD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4281
Practice Address - Country:US
Practice Address - Phone:248-922-9200
Practice Address - Fax:248-922-9700
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist