Provider Demographics
NPI:1043855158
Name:ALBRECHT, BONITA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:MARIE
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21692 435TH AVE
Mailing Address - Street 2:
Mailing Address - City:DE SMET
Mailing Address - State:SD
Mailing Address - Zip Code:57231-7015
Mailing Address - Country:US
Mailing Address - Phone:605-203-0296
Mailing Address - Fax:605-854-3598
Practice Address - Street 1:411 CALUMET AVE NE
Practice Address - Street 2:
Practice Address - City:DE SMET
Practice Address - State:SD
Practice Address - Zip Code:57231
Practice Address - Country:US
Practice Address - Phone:605-854-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant