MEDICARE: KIM R BUGLIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	TEI001926	PA

General Provider Information

NPI Number	:	1366218596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM R BUGLIO

Provider Business Mailing Address
First Line	:	PO BOX 305
Second Line	:
City	:	CONYNGHAM
State	:	PA
Zip	:	18219-0305
Country	:	US
Telephone Number	:	570-956-1255
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 MYERS AVE
Second Line	:
City	:	CONYNGHAM
State	:	PA
Zip	:	18219-1821
Country	:	US
Telephone Number	:	570-956-1255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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Directions to “ KIM R BUGLIO ” Practice Location

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