Provider Demographics
NPI:1861029258
Name:BANGURA, FATMATA M (DPT)
Entity type:Individual
Prefix:
First Name:FATMATA
Middle Name:M
Last Name:BANGURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:6856 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:571-348-1201
Practice Address - Fax:571-302-8633
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27879225100000X
VACP010037T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist