Bonnie Iris Buyum, PTA

Key facts

NPI

1124248588

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

TE005792L (PA)

Practice address

905 Penllyn Pike
Spring House, PA 19477

Phone

(215) 646-1500

NPI assigned

Apr 26, 2007

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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

• Silver Stream Center Skilled Nursing Facility · Spring House, PA · NPI 1841311990
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124248588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S EASTON RD",
            "address_2": "APT B406",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190383927",
            "telephone_number": "215-886-8098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 PENLLYN PIKE",
            "city": "SPRING HOUSE",
            "state": "PA",
            "postal_code": "19477",
            "telephone_number": "215-646-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUYUM",
        "first_name": "BONNIE",
        "middle_name": "IRIS",
        "name_prefix": "Ms.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE005792L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Spring House, PA · Physical Therapy Assistant in Pennsylvania