Provider Demographics
NPI:1053681965
Name:BONO, VERONICA (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BONO
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 N FEDERAL HWY APT 113A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5501
Mailing Address - Country:US
Mailing Address - Phone:954-640-3568
Mailing Address - Fax:
Practice Address - Street 1:1615 MIAMI RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2933
Practice Address - Country:US
Practice Address - Phone:954-763-6763
Practice Address - Fax:954-763-6760
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21053225200000X
FLMA41431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist