Provider Demographics
NPI:1295963510
Name:BUNDY, ANAMARIA HOFFMAN (LPTA)
Entity type:Individual
Prefix:
First Name:ANAMARIA
Middle Name:HOFFMAN
Last Name:BUNDY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:BUNDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:1111 AZALEA TRL
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-2721
Mailing Address - Country:US
Mailing Address - Phone:252-340-3218
Mailing Address - Fax:
Practice Address - Street 1:1111 AZALEA TRL
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-2721
Practice Address - Country:US
Practice Address - Phone:252-340-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2363225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant