Provider Demographics
NPI:1942503784
Name:BUNDRA, JADE T (DPT)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:T
Last Name:BUNDRA
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 1:1718 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9784
Mailing Address - Country:US
Mailing Address - Phone:610-366-0500
Mailing Address - Fax:
Practice Address - Street 1:1718 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9784
Practice Address - Country:US
Practice Address - Phone:610-366-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist