Provider Demographics
NPI:1073950903
Name:BONVENTO, ASHLEY (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:
Last Name:BONVENTO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8846 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4530
Mailing Address - Country:US
Mailing Address - Phone:561-719-2023
Mailing Address - Fax:
Practice Address - Street 1:4362 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6275
Practice Address - Country:US
Practice Address - Phone:561-625-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist