Provider Demographics
NPI:1770977522
Name:DRURY, KEVIN (P T)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DRURY
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8876 MISSISSIPPI RUN
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-8208
Mailing Address - Country:US
Mailing Address - Phone:352-442-8897
Mailing Address - Fax:
Practice Address - Street 1:8876 MISSISSIPPI RUN
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-8208
Practice Address - Country:US
Practice Address - Phone:352-442-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist