Provider Demographics
NPI:1851958359
Name:BONNER, ALLYSON DAWN (LPTA)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:DAWN
Last Name:BONNER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7612
Mailing Address - Country:US
Mailing Address - Phone:989-891-9800
Mailing Address - Fax:
Practice Address - Street 1:2535 22ND ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7612
Practice Address - Country:US
Practice Address - Phone:989-891-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005893225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant