Provider Demographics
NPI:1366218596
Name:BUGLIO, KIM R
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:R
Last Name:BUGLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219-0305
Mailing Address - Country:US
Mailing Address - Phone:570-956-1255
Mailing Address - Fax:
Practice Address - Street 1:48 MYERS AVE
Practice Address - Street 2:
Practice Address - City:CONYNGHAM
Practice Address - State:PA
Practice Address - Zip Code:18219-1821
Practice Address - Country:US
Practice Address - Phone:570-956-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant