Provider Demographics
NPI:1760519417
Name:KIMMELMAN, BONNIE K (MED, PT)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:K
Last Name:KIMMELMAN
Suffix:
Gender:F
Credentials:MED, PT
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:P
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, PT
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:33 MORGAN DR
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-0727
Mailing Address - Country:US
Mailing Address - Phone:603-643-7788
Mailing Address - Fax:603-643-0022
Practice Address - Street 1:33 MORGAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1408
Practice Address - Country:US
Practice Address - Phone:603-643-7788
Practice Address - Fax:603-643-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009398Medicaid
VTORE5196Medicaid
NH30009398Medicaid