Basic Information
Provider Information
NPI: 1477616696
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZIEGELSTEIN
FirstName: BONNIE
MiddleName: ENGEL
NamePrefix: MS.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3509 WOODVALLEY DR
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212081731
CountryCode: US
TelephoneNumber: 4104849482
FaxNumber:  
Practice Location
Address1: 10753 FALLS RD
Address2: SUITE 235
City: LUTHERVILLE
State: MD
PostalCode: 210934535
CountryCode: US
TelephoneNumber: 4105832665
FaxNumber: 4108473838
Other Information
ProviderEnumerationDate: 12/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X15705MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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