Provider Demographics
NPI:1437469509
Name:MISKELL, BONNIE LEE (AAS)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LEE
Last Name:MISKELL
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DIMATTEO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6470
Mailing Address - Country:US
Mailing Address - Phone:716-435-8834
Mailing Address - Fax:
Practice Address - Street 1:106 DIMATTEO DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6470
Practice Address - Country:US
Practice Address - Phone:716-435-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006591-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant