Provider Demographics
NPI:1396811006
Name:BRONSON, MARGARET KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:KATHLEEN
Last Name:BRONSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:KATHLEEN
Other - Last Name:BRYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11143 PARKVIEW PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1728
Practice Address - Country:US
Practice Address - Phone:260-266-7400
Practice Address - Fax:260-266-7439
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008097A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
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IN200443000AMedicaid
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IN000000314469OtherANTHEM BCBS
IN1424OtherPHP
IN4423623OtherAETNA