Provider Demographics
NPI:1114025418
Name:DENNIS JAMES BONNER, MD, LTD
Entity Type:Organization
Organization Name:DENNIS JAMES BONNER, MD, LTD
Other - Org Name:INDUSTRIAL HEALTH CARE, CENTER FOR REHAB AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-677-0930
Mailing Address - Street 1:126 S STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3524
Mailing Address - Country:US
Mailing Address - Phone:215-579-6991
Mailing Address - Fax:215-579-9774
Practice Address - Street 1:126 S STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3524
Practice Address - Country:US
Practice Address - Phone:215-579-6991
Practice Address - Fax:215-579-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005508L225100000X
PAPT008212-L225100000X
PAMA052018-LPA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ46701Medicare UPIN
PAS73650Medicare UPIN
PA024139H6YMedicare ID - Type UnspecifiedMEDICARE
PAS71291Medicare UPIN
PA023229H6YMedicare ID - Type UnspecifiedMDEICARE
PA092202H64Medicare ID - Type UnspecifiedMEDICARE