Provider Demographics
NPI:1275142598
Name:DEL ROSARIO, BONNIE DONAIRE (PT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:DONAIRE
Last Name:DEL ROSARIO
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 1:137 W VIENNA ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1656
Mailing Address - Country:US
Mailing Address - Phone:618-697-3606
Mailing Address - Fax:
Practice Address - Street 1:1000 LEIGH AVE
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-2232
Practice Address - Country:US
Practice Address - Phone:618-833-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist