Provider Demographics
NPI:1891806501
Name:BEDONI, KELLIE BONNER (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:BONNER
Last Name:BEDONI
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:MARIE
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:405 PEARL STREET
Mailing Address - Street 2:NORTH SUBURBAN ORTHOPEDIC ASSOCIATES INC
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-321-8785
Mailing Address - Fax:781-321-8063
Practice Address - Street 1:602 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149
Practice Address - Country:US
Practice Address - Phone:671-389-7211
Practice Address - Fax:617-389-7225
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
612930OtherTUFTS GROUP
613542OtherHARVARD PILGRIM GROUP
Y67652OtherBCBS INDIVIDUAL
0000Y61011OtherBCBS GROUP
0000Y61011OtherBCBS GROUP
613542OtherHARVARD PILGRIM GROUP