Active NPI
Mary B Bulriss, PT
- Physical Therapist
- Charleston, WV
National Provider Identifier
1629754239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT004171
- Practice address
- 600 Tracy Way
Charleston, WV 25311-1262 - Phone
- (304) 388-4900
- NPI assigned
- Jun 27, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT004171 | WV | Primary |
Addresses
Primary practice location
600 Tracy Way
Charleston, WV 25311-1262
Mailing address
400 Association Dr Ste 102
Charleston, WV 25311-1298
Phone (304) 388-1724
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT004171 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1629754239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 ASSOCIATION DR STE 102",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253111298",
"telephone_number": "304-388-1724",
"fax_number": "304-388-1721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 TRACY WAY",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253111262",
"telephone_number": "304-388-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULRISS",
"first_name": "MARY",
"middle_name": "B",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-27",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT004171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.