Provider Demographics
NPI:1003840976
Name:BONEWICZ, MELISSA MEGHAN (PHYSICAL THARAPIST)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MEGHAN
Last Name:BONEWICZ
Suffix:
Gender:F
Credentials:PHYSICAL THARAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FRIES MILL RD STE 600
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2016
Mailing Address - Country:US
Mailing Address - Phone:856-374-3707
Mailing Address - Fax:856-374-3708
Practice Address - Street 1:151 FRIES MILL RD STE 1
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-3707
Practice Address - Fax:856-374-3708
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01135200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
085588Medicare ID - Type Unspecified