Marie Antonette Balderama Bongalonta

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1229668 Issued in TX

Practice address

1580 Sawgrass Corporate Pkwy
Suite 100
Sunrise, FL 33323-2859

Phone

(312) 608-8211

NPI assigned

Dec 11, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Medpro Healthcare Staffing

  • Rehabilitation Hospital
  • Sunrise, FL
  • NPI 1922342021
  NPD (past)

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1346671641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 SAWGRASS CORPORATE PKWY",
            "address_2": "SUITE 100",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232859",
            "telephone_number": "312-608-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 SAWGRASS CORPORATE PKWY",
            "address_2": "SUITE 100",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232859",
            "telephone_number": "312-608-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGALONTA",
        "first_name": "MARIE ANTONETTE",
        "middle_name": "BALDERAMA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-11",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1229668",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070020367",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "009965",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "1258924",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonina Daum Bolton, PH.D.
• Judith Ann Bona, NNP
• Caroline Elizabeth Bond, OTR, MSC
• Katherine Bonetti
• Kristina Bonfield, SLP
• Daniela Bonilla Escamilla
• Andrea F Bonkosky, LCSW
• Alejandra Maria Bonner
• Bridjette Booker, REGISTERED NURSE
• Boost Medical LLC

• Physical Therapist in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.