Provider Demographics
NPI:1063861722
Name:BONDURANT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BONDURANT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-528-2326
Mailing Address - Street 1:85 PAINE ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1154
Mailing Address - Country:US
Mailing Address - Phone:515-528-2326
Mailing Address - Fax:515-528-2327
Practice Address - Street 1:85 PAINE ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-1154
Practice Address - Country:US
Practice Address - Phone:515-528-2326
Practice Address - Fax:515-528-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty