Bronsun Bouyasith Phengdy, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

10450 W McDowell Rd
Avondale, AZ 85392-4901

Phone

(623) 846-7614

NPI assigned

Aug 9, 2022

Sex

Male

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

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.

• Orthopedic Specialists of North America, PLLC

  • Orthopaedic Surgery Physician
  • Phoenix, AZ
  • NPI 1770812828
  NPD (past)

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1417685397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 W HIGHLAND AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850154028",
            "telephone_number": "623-414-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10450 W MCDOWELL RD",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853924901",
            "telephone_number": "623-846-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHENGDY",
        "first_name": "BRONSUN",
        "middle_name": "BOUYASITH",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Suzanne Petrarca
• Mark Alan Pezzelle, P.T.A.
• Tawnya Suzanne Pfitzer, DPM
• Brian Phan, RPH
• Thihan Phan, DDS
• Dametria Phillips
• Phoenix Children'S Hospital, Inc.
• Phoenix Children'S Medical Group
• Phoenix Diagnostic Imaging Inc
• Phoenix Family Psychiatry LLC

• Physical Therapy Assistant in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Physical Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.