Healthcare Provider Details

I. General information

NPI: 1801117098
Provider Name (Legal Business Name): MRS. AMORY HARTNETT BUNCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7781 BAYSIDE RD
FRANKTOWN VA
23354
US

IV. Provider business mailing address

PO BOX 641
NASSAWADOX VA
23413-0641
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-4758
  • Fax:
Mailing address:
  • Phone: 757-442-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306000390
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: