Provider Demographics
NPI:1255685806
Name:BONFIGLIO, LAURA S (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:BONFIGLIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-1432
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:STE 148C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-265-5000
Practice Address - Fax:615-265-5005
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN83642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic