Provider Demographics
NPI:1477667582
Name:BONAR, KERRY BARNHOLT (PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:BARNHOLT
Last Name:BONAR
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 1:1925 FORDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4009
Mailing Address - Country:US
Mailing Address - Phone:650-823-9749
Mailing Address - Fax:
Practice Address - Street 1:1925 FORDHAM WAY
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4009
Practice Address - Country:US
Practice Address - Phone:650-823-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8665225100000X
CA35516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist