Provider Demographics
NPI:1235455759
Name:BUNAG, JOSEPHINE ALEGADO (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ALEGADO
Last Name:BUNAG
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 1:2407 PENNINGTON PL
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9187
Mailing Address - Country:US
Mailing Address - Phone:219-689-5159
Mailing Address - Fax:219-531-5635
Practice Address - Street 1:2407 PENNINGTON PL
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-9187
Practice Address - Country:US
Practice Address - Phone:219-689-5159
Practice Address - Fax:219-531-5635
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005375A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist