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 1:9823 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2347
Mailing Address - Country:US
Mailing Address - Phone:260-497-7191
Mailing Address - Fax:
Practice Address - Street 1:4303 LAHMEYER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5677
Practice Address - Country:US
Practice Address - Phone:260-443-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2025-08-25
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
StateIdentifier IDID TypeIssuer
IN156572OtherMEDICARE
IN200443000AMedicaid
IN35179001202OtherCARESOURCE
IN4423623OtherAETNA
INN242400OtherHARMONY
IN11456687OtherCAQH
IN1424OtherPHP
IN4423623OtherAETNA