Provider Demographics
NPI:1104822873
Name:BRONSORD, ARTHUR CLARENCE (PT)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:CLARENCE
Last Name:BRONSORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:ARTHUR
Other - Middle Name:CLARENCE
Other - Last Name:BRONSORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:20098 ASHBROOK PL
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3393
Mailing Address - Country:US
Mailing Address - Phone:703-723-5225
Mailing Address - Fax:703-723-5595
Practice Address - Street 1:20098 ASHBROOK PL
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3393
Practice Address - Country:US
Practice Address - Phone:703-723-5225
Practice Address - Fax:703-723-5595
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V628A55Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER