Provider Demographics
NPI:1376650853
Name:BUNNER, TONYA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:BUNNER
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 1:3124 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1227
Mailing Address - Country:US
Mailing Address - Phone:520-325-4002
Mailing Address - Fax:520-325-4227
Practice Address - Street 1:3124 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1227
Practice Address - Country:US
Practice Address - Phone:520-325-4002
Practice Address - Fax:520-325-4227
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ630659Medicaid
AZ630659Medicaid
AZZ67517Medicare PIN