Provider Demographics
NPI:1720036775
Name:LONGLEY, BONNIE L (ATC,EMT,CSCS)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:LONGLEY
Suffix:
Gender:F
Credentials:ATC,EMT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5657
Mailing Address - Country:US
Mailing Address - Phone:203-259-7177
Mailing Address - Fax:203-256-9217
Practice Address - Street 1:2119 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5657
Practice Address - Country:US
Practice Address - Phone:203-259-7177
Practice Address - Fax:203-256-9217
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer