Provider Demographics
NPI:1558192575
Name:BUNGARD, NATHANAEL OWEN (DPT)
Entity type:Individual
Prefix:MR
First Name:NATHANAEL
Middle Name:OWEN
Last Name:BUNGARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 ROSTRAVER RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012
Mailing Address - Country:US
Mailing Address - Phone:724-243-3728
Mailing Address - Fax:724-320-2254
Practice Address - Street 1:638 ROSTRAVER RD
Practice Address - Street 2:STE 104
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012
Practice Address - Country:US
Practice Address - Phone:724-243-3728
Practice Address - Fax:724-320-2254
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist