Provider Demographics
NPI:1083982821
Name:SPERBERG, BONNIE J (PT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:SPERBERG
Suffix:
Gender:F
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:N4723 26TH LN
Mailing Address - Street 2:
Mailing Address - City:PINE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54965-8131
Mailing Address - Country:US
Mailing Address - Phone:920-622-5248
Mailing Address - Fax:
Practice Address - Street 1:1226 BERLIN ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1991
Practice Address - Country:US
Practice Address - Phone:715-942-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2211-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist