Healthcare Provider Details

I. General information

NPI: 1518955079
Provider Name (Legal Business Name): KAREN NANCY BONSACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 NEWPORT DR STE A
FOREST HILL MD
21050-1758
US

IV. Provider business mailing address

12 NEWPORT DR STE A
FOREST HILL MD
21050-1758
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9600
  • Fax: 410-838-2511
Mailing address:
  • Phone: 410-838-9600
  • Fax: 410-838-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15890
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: