Provider Demographics
NPI:1306837828
Name:BONGIORNO, KAMALA N (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KAMALA
Middle Name:N
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KAMALA
Other - Middle Name:N
Other - Last Name:GERHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:676 DEKALB PIKE
Mailing Address - Street 2:STE 205
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1223
Mailing Address - Country:US
Mailing Address - Phone:610-270-0370
Mailing Address - Fax:610-270-0374
Practice Address - Street 1:676 DEKALB PIKE
Practice Address - Street 2:STE 105-106
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1223
Practice Address - Country:US
Practice Address - Phone:610-270-0300
Practice Address - Fax:610-270-8863
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012633L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
061957QYQMedicare ID - Type Unspecified