Provider Demographics
NPI:1558616748
Name:BEDONIA, RUTH ELAINE VERGARA (PT)
Entity Type:Individual
Prefix:MS
First Name:RUTH ELAINE
Middle Name:VERGARA
Last Name:BEDONIA
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 1:3050 CHAMPION RING RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5599
Mailing Address - Country:US
Mailing Address - Phone:239-313-2900
Mailing Address - Fax:
Practice Address - Street 1:3050 CHAMPION RING RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5599
Practice Address - Country:US
Practice Address - Phone:239-313-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25283225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist