Vicki Ellen Brungard, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TE1001946 Issued in PA

Practice address

1705 Warren Ave Ste 102
Williamsport, PA 17701

Phone

(570) 320-7470

Fax

(570) 320-7471

NPI assigned

Jul 11, 2019

Last updated

Jul 11, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1114579075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 MILL RD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177028122",
            "telephone_number": "570-419-6316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 WARREN AVE STE 102",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "17701",
            "telephone_number": "570-320-7470",
            "fax_number": "570-320-7471"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1705 Warren Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Williamsport",
            "state": "PA",
            "postal_code": "17701",
            "country_code": "US",
            "telephone_number": "570-320-7470",
            "fax_number": "570-320-7471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNGARD",
        "first_name": "VICKI",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE1001946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ann Marie Bruno, PSY.D
• Timothy Allen Bryant, PHD
• Darin Bubb, PT
• Katrina Buckland, DPT
• Oriana Bughi, PA-C

• Physical Therapy Assistant in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.