Provider Demographics
NPI:1689763807
Name:BONAROS, MELISSA PAIGE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:PAIGE
Last Name:BONAROS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-6036
Mailing Address - Country:US
Mailing Address - Phone:954-290-1404
Mailing Address - Fax:
Practice Address - Street 1:9699 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4001
Practice Address - Country:US
Practice Address - Phone:954-344-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist