Provider Demographics
NPI:1821766643
Name:BONDARENKO, EMILY RENAE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RENAE
Last Name:BONDARENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RENAE
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11471 TAMPA AVE UNIT 151
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1783
Mailing Address - Country:US
Mailing Address - Phone:605-760-0984
Mailing Address - Fax:
Practice Address - Street 1:6833 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2511
Practice Address - Country:US
Practice Address - Phone:877-550-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT300729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist