Individual provider Active NPI

Mary Bunnell, DPT

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1336346444
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
2 Doctors Dr
Greenville, SC 29605-4265
Phone
(864) 558-8955
Fax
(864) 794-5439
NPI assigned
Jul 2, 2007
Last updated
May 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 005119 KY
Physical Therapist 225100000X SC Primary

Addresses

Primary practice location

2 Doctors Dr
Greenville, SC 29605-4265

Mailing address

790 Remington Blvd Ste 175
Bolingbrook, IL 60440-4909

Other practice location 1

600 Perimeter Dr
Suite 175
Lexington, KY 40517-4119
Phone (859) 268-1201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005119KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Jul 13, 2024 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Jul 13, 2024 Accepting new patients
Kentucky Hand and Physical Therapy BC LLC Physical Therapist Past Accepting new patients
Drayer Physical Therapy Kentucky LLC Physical Therapist PastSince Sep 27, 2020 Accepting new patients
Drayer Physical Therapy Institute of Kentucky PLLC Physical Therapist Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

790 Remington Blvd
Ste 175
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

2 Doctors Dr
Greenville, SC 29605
Phone (864) 558-8955

Organizations & group practices 5

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1336346444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD STE 175",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DOCTORS DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054265",
            "telephone_number": "864-558-8955",
            "fax_number": "864-794-5439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Perimeter Dr",
            "address_2": "Suite 175",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405174119",
            "country_code": "US",
            "telephone_number": "859-268-1201",
            "fax_number": "859-268-1202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNNELL",
        "first_name": "MARY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "005119",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; 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.