Provider Demographics
NPI:1417067448
Name:BONNER, CATHERINE C (MSPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:BONNER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 WOODRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-3043
Mailing Address - Country:US
Mailing Address - Phone:205-995-1776
Mailing Address - Fax:
Practice Address - Street 1:727 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2218
Practice Address - Country:US
Practice Address - Phone:256-362-9477
Practice Address - Fax:256-362-9255
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47130Medicare ID - Type Unspecified