Provider Demographics
NPI:1518955079
Name:BONSACK, KAREN NANCY (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:NANCY
Last Name:BONSACK
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 1:12 NEWPORT DR STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1758
Mailing Address - Country:US
Mailing Address - Phone:410-838-9600
Mailing Address - Fax:410-838-2511
Practice Address - Street 1:12 NEWPORT DR STE A
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1758
Practice Address - Country:US
Practice Address - Phone:410-838-9600
Practice Address - Fax:410-838-2511
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J044OtherBCBS
T350OtherFEDERAL BCBS
650003301OtherMC RAILROAD
146498900OtherWC FED
J044OtherBCBS