Provider Demographics
NPI:1528190014
Name:GARDNER, BONITA K (PTA)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:K
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HASSINGER RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17240-9370
Mailing Address - Country:US
Mailing Address - Phone:717-423-6395
Mailing Address - Fax:
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:CHAMBERSBURG HOSPITAL - PHYSICAL MEDICINE DEPARTMENT
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7715
Practice Address - Fax:717-267-7463
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000196L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant