Provider Demographics
NPI:1336332188
Name:MAGLIO, BONNIDENE MARIE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:BONNIDENE
Middle Name:MARIE
Last Name:MAGLIO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18740 W BLUEMOUND RD
Mailing Address - Street 2:BROOKFIELD REHAB & SPECIALTY CARE
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-782-0230
Mailing Address - Fax:262-797-8306
Practice Address - Street 1:18740 W BLUEMOUND RD
Practice Address - Street 2:BROOKFIELD REHAB & SPECIALTY CARE
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-782-0230
Practice Address - Fax:262-797-8306
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
167019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40187300Medicaid