Provider Demographics
NPI:1609101104
Name:BONDURANT, ASHLEY R (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:BONDURANT
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 1:314 FRANKLIN AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1215
Mailing Address - Country:US
Mailing Address - Phone:410-641-0999
Mailing Address - Fax:410-641-9576
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-641-0999
Practice Address - Fax:410-641-9576
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23086225100000X
SC7438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23086OtherSTATE LICENSE
SC7438OtherPT LICENSE