Provider Demographics
NPI:1265138044
Name:BUNDUS, HANNAH TOMKO (PT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:TOMKO
Last Name:BUNDUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-817-3599
Mailing Address - Fax:
Practice Address - Street 1:8620 BIGGIN HILL LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4117
Practice Address - Country:US
Practice Address - Phone:859-817-3599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015385225100000X
KYCP018284T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100877130Medicaid
OHPT015385OtherPT LICENSE OH
KY419750OtherMEDICARE KY
KYCP018284TOtherPT COMPACT LICENSE