Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 21987 | MD |
N | 2251S0007X | Physical Therapist - Sports | 21987 | MD |
Y | 2251X0800X | Physical Therapist - Orthopedic | 21987 | MD |
NPI | 1336260413 |
---|---|
Provider Name | Adwoa K Bonsra |
First Address | Lutherville, MD 21093-6240 |
Second Address | Baltimore, MD 21236-4088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 06/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
074738600 | (05) | MD |