Provider Demographics
NPI:1194827519
Name:WILLIAMS, BONNIE JO (PT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:WILLIAMS
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 1:616 E HYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2391
Mailing Address - Country:US
Mailing Address - Phone:970-925-1808
Mailing Address - Fax:970-920-6535
Practice Address - Street 1:616 E HYMAN
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-925-1808
Practice Address - Fax:970-920-6535
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2053208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807419Medicare PIN