Provider Demographics
NPI:1508333980
Name:FLEISCHMAN, BONNIE LASHLEE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LASHLEE
Last Name:FLEISCHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FARLEY LN
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-8616
Mailing Address - Country:US
Mailing Address - Phone:270-779-7328
Mailing Address - Fax:
Practice Address - Street 1:5079 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7897
Practice Address - Country:US
Practice Address - Phone:270-781-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist