Provider Demographics
NPI:1114325230
Name:KOHL, BONNIE CATHERINE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:CATHERINE
Last Name:KOHL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 COVINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-7208
Mailing Address - Country:US
Mailing Address - Phone:605-787-2719
Mailing Address - Fax:
Practice Address - Street 1:412 OSHKOSH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2420
Practice Address - Country:US
Practice Address - Phone:605-787-2719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-06
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037987-1225100000X
SD1775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist