Provider Demographics
NPI:1013036003
Name:BONAVITA, WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BONAVITA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2010
Mailing Address - Country:US
Mailing Address - Phone:413-599-1545
Mailing Address - Fax:413-599-0445
Practice Address - Street 1:28 SHADY LN
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-2010
Practice Address - Country:US
Practice Address - Phone:413-599-1545
Practice Address - Fax:413-599-0445
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist