Individual provider Active NPI

Mira Bunch

  • Physical Therapist
  • Crown Point, IN
National Provider Identifier
1508776717
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05016462A Issued in IN
Practice address
11496 Broadway
Crown Point, IN 46307-7106
Phone
(219) 213-2222
NPI assigned
Sep 9, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05016462A IN Primary

Addresses

Primary practice location

11496 Broadway
Crown Point, IN 46307-7106

Mailing address

11505 Belmont PL
Cedar Lake, IN 46303-8941

Medicare participation

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

NPI Registry JSON

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

{
    "created_epoch": "1788912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1508776717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11505 BELMONT PL",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463038941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11496 BROADWAY",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077106",
            "telephone_number": "219-213-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNCH",
        "first_name": "MIRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-09",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05016462A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.