1912159955 NPI number — MRS. HEATHER LEANNE BUONOCORE P.T.

Table of content: MRS. HEATHER LEANNE BUONOCORE P.T. (NPI 1912159955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912159955 NPI number — MRS. HEATHER LEANNE BUONOCORE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUONOCORE
Provider First Name:
HEATHER
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAINES
Provider Other First Name:
HEATHER
Provider Other Middle Name:
LEANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912159955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 FREDERICKSBURG DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEPHENS CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22655-4542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-868-0408
Provider Business Mailing Address Fax Number:
540-868-0408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 FREDERICKSBURG DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEPHENS CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22655-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-868-0408
Provider Business Practice Location Address Fax Number:
540-868-0408
Provider Enumeration Date:
10/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305004456 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com