Provider Demographics
NPI:1730895509
Name:BONGIORNO, DANIELLE MARIE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:PURGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC, OMPT
Mailing Address - Street 1:1824 HICKORY BARK LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1116
Mailing Address - Country:US
Mailing Address - Phone:586-929-0580
Mailing Address - Fax:
Practice Address - Street 1:3297 FIVE POINTS DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2337
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:586-275-0735
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302292225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic