1730895509 NPI number — DANIELLE MARIE BONGIORNO

Table of content: DANIELLE MARIE BONGIORNO (NPI 1730895509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730895509 NPI number — DANIELLE MARIE BONGIORNO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONGIORNO
Provider First Name:
DANIELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PURGAR
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, ATC, OMPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730895509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1824 HICKORY BARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48304-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-929-0580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3297 FIVE POINTS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48326-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-353-1234
Provider Business Practice Location Address Fax Number:
586-275-0735
Provider Enumeration Date:
01/25/2023

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:  5501302292 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: 5501302292 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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