Provider Demographics
NPI:1508904889
Name:BONTRAGER, PHILLIP
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:BONTRAGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ROCK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-6435
Mailing Address - Country:US
Mailing Address - Phone:615-336-3505
Mailing Address - Fax:
Practice Address - Street 1:3310 PERIMETER HILL DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4123
Practice Address - Country:US
Practice Address - Phone:615-250-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health