Provider Demographics
NPI:1386183531
Name:BONNER, KARABETH (PTA)
Entity Type:Individual
Prefix:MISS
First Name:KARABETH
Middle Name:
Last Name:BONNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13635 E 104TH AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-8409
Mailing Address - Country:US
Mailing Address - Phone:720-506-5340
Mailing Address - Fax:
Practice Address - Street 1:13635 E 104TH AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-8409
Practice Address - Country:US
Practice Address - Phone:720-506-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014071225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant