Provider Demographics
NPI:1366854267
Name:BONNETTE, ALEX (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BONNETTE
Suffix:
Gender:M
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 1:9660 BARTLETT CIR STE 708
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4465
Mailing Address - Country:US
Mailing Address - Phone:817-862-9665
Mailing Address - Fax:817-862-9667
Practice Address - Street 1:9660 BARTLETT CIR STE 708
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108
Practice Address - Country:US
Practice Address - Phone:817-862-9665
Practice Address - Fax:817-862-9667
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1242490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist