Provider Demographics
NPI:1396441010
Name:BRONO, SEPTEMBER GRACE EVANGELISTA (PTA,PT,DPT)
Entity type:Individual
Prefix:
First Name:SEPTEMBER GRACE
Middle Name:EVANGELISTA
Last Name:BRONO
Suffix:
Gender:F
Credentials:PTA,PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21726 138TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2608
Mailing Address - Country:US
Mailing Address - Phone:347-572-2447
Mailing Address - Fax:
Practice Address - Street 1:615 AVENUE C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4101
Practice Address - Country:US
Practice Address - Phone:718-633-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01219901225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant