Provider Demographics
NPI:1336260413
Name:BONSRA BOADI, ADWOA K (PT)
Entity Type:Individual
Prefix:
First Name:ADWOA
Middle Name:K
Last Name:BONSRA BOADI
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:1212 YORK RD
Mailing Address - Street 2:SUITE C-101
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6240
Mailing Address - Country:US
Mailing Address - Phone:410-321-0377
Mailing Address - Fax:410-821-7517
Practice Address - Street 1:7672 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4088
Practice Address - Country:US
Practice Address - Phone:410-663-6450
Practice Address - Fax:410-663-6451
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2024-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD219872251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD074738600Medicaid