Provider Demographics
NPI:1972085611
Name:BOSITA, MONINA TERESA BERMUNDO (PT)
Entity Type:Individual
Prefix:
First Name:MONINA TERESA
Middle Name:BERMUNDO
Last Name:BOSITA
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 1:4309 N 10TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3020
Mailing Address - Country:US
Mailing Address - Phone:956-664-0888
Mailing Address - Fax:
Practice Address - Street 1:4309 N 10TH ST STE E
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3020
Practice Address - Country:US
Practice Address - Phone:956-664-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist