Individual provider Active NPI

Laura Bunso, PT

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1053502393
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
018144 Issued in FL
Practice address
12421 San Jose Blvd # 100a
Jacksonville, FL 32223-2680
Phone
(904) 296-4140
Fax
(904) 279-0963
NPI assigned
Aug 1, 2007
Last updated
Apr 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 018144 FL Primary

Addresses

Primary practice location

12421 San Jose Blvd # 100a
Jacksonville, FL 32223-2680

Mailing address

10950 60 San Jose Blvd 196
Jacksonville, FL 32223-2336
Phone (904) 296-4140

Other practice location 1

165 Hampton Point Dr Ste 3A
St Augustine, FL 32092-3062
Phone (904) 296-4140

Other practice location 2

30 Tavernier Dr Ste A
Ponte Vedra, FL 32081-1270
Phone (904) 296-4140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041012001280 FL Practitioner - Physical Therapist in Private Practice 3870553043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Smart Body Physical Therapy IncGroup PAC ID 0648217240, 6 clinicians

Practice addresses (Care Compare)

12421 San Jose Blvd
Suite 100
Jacksonville, FL 32223-8662
Phone (904) 296-4140

30 Tavernier Dr
Suite a
Ponte Vedra, FL 32081-1270
Phone (904) 296-4140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
018144FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Smart Body Physical Therapy Inc Current Accepting new patients

Locations

10950 San Jose Blvd
#196
Jacksonville, FL 32223

11555 Central Pkwy
Ste 202
Jacksonville, FL 32224
Phone (904) 296-4140

6885 Belfort Oaks Pl
Ste 310
Jacksonville, FL 32216
Phone (904) 296-4140

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1053502393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10950 60 SAN JOSE BLVD 196",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322232336",
            "telephone_number": "904-296-4140",
            "fax_number": "904-279-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12421 SAN JOSE BLVD # 100A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322232680",
            "telephone_number": "904-296-4140",
            "fax_number": "904-279-0963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "165 Hampton Point Dr Ste 3A",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320923062",
            "country_code": "US",
            "telephone_number": "904-296-4140",
            "fax_number": "904-279-0963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "30 Tavernier Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Ponte Vedra",
            "state": "FL",
            "postal_code": "320811270",
            "country_code": "US",
            "telephone_number": "904-296-4140",
            "fax_number": "904-279-0963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNSO",
        "first_name": "LAURA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-01",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "018144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.