Provider Demographics
NPI:1578778924
Name:BONEPARTH, MARIE (PT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BONEPARTH
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 1:20 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3113
Mailing Address - Country:US
Mailing Address - Phone:207-773-5778
Mailing Address - Fax:
Practice Address - Street 1:100 FORE ST
Practice Address - Street 2:FL 2
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4879
Practice Address - Country:US
Practice Address - Phone:207-773-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist