Provider Demographics
NPI:1396865192
Name:BONDURANT, JANE ELLISON (PT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLISON
Last Name:BONDURANT
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 1:52544 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5972
Mailing Address - Country:US
Mailing Address - Phone:803-396-5603
Mailing Address - Fax:803-547-5693
Practice Address - Street 1:831 MCDOW DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2415
Practice Address - Country:US
Practice Address - Phone:803-324-9762
Practice Address - Fax:803-324-9873
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist