Provider Demographics
NPI:1053502393
Name:BUNSO, LAURA (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BUNSO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6639 SOUTHPOINT PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8042
Mailing Address - Country:US
Mailing Address - Phone:904-296-4140
Mailing Address - Fax:904-279-0963
Practice Address - Street 1:6639 SOUTHPOINT PKWY STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8042
Practice Address - Country:US
Practice Address - Phone:904-296-4140
Practice Address - Fax:904-279-0963
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL018144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist