1104822873 NPI number — MR. ARTHUR CLARENCE BRONSORD P.T.

Table of content: MR. ARTHUR CLARENCE BRONSORD P.T. (NPI 1104822873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104822873 NPI number — MR. ARTHUR CLARENCE BRONSORD P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRONSORD
Provider First Name:
ARTHUR
Provider Middle Name:
CLARENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRONSORD
Provider Other First Name:
ARTHUR
Provider Other Middle Name:
CLARENCE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104822873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20098 ASHBROOK PL
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-3393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-723-5225
Provider Business Mailing Address Fax Number:
703-723-5595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20098 ASHBROOK PL
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-3393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-723-5225
Provider Business Practice Location Address Fax Number:
703-723-5595
Provider Enumeration Date:
06/27/2005

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:  2305003034 , 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