Provider Demographics
NPI:1114138393
Name:FERACO, BONNIE JO D
Entity Type:Individual
Prefix:MRS
First Name:BONNIE JO
Middle Name:D
Last Name:FERACO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-1276
Mailing Address - Country:US
Mailing Address - Phone:609-522-3022
Mailing Address - Fax:
Practice Address - Street 1:1801 N ROUTE 9
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1436
Practice Address - Country:US
Practice Address - Phone:609-463-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00755500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist