Venkata Jaya Madhuri Bongarala, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070011570 Issued in IL

Practice address

3001 Green Bay Rd
Captain James a. Lovell Federal Health Care Center
North Chicago, IL 60064-3048

Phone

(224) 619-5114

NPI assigned

Jan 27, 2015

Sex

Female

Sole proprietor

No

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

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422316800000",
    "number": "1518357656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 THRUSH CIR",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600467949",
            "telephone_number": "847-668-4744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 GREEN BAY RD",
            "address_2": "CAPTAIN JAMES A. LOVELL FEDERAL HEALTH CARE CENTER",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "600643048",
            "telephone_number": "224-619-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGARALA",
        "first_name": "VENKATA",
        "middle_name": "JAYA MADHURI",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070011570",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05006453A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00867600",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501008631",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annette Facinelli Boban, PA-C
• Jessica Marie Boh, PHARMD
• Terri Bohlman, MSW
• Kimberly Boit
• Michael Boler
• Jeremiah Bonner
• Kathryn Ann Bonovich, R.PH.
• Amy Lynn Borden, LCSW
• Ronen Bordoloi
• Kristy Borges, LCSW

• Physical Therapist in North Chicago, IL
• Providers in North Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; 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.