Provider Demographics
NPI:1922061951
Name:BONO, MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BONO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-454-4864
Mailing Address - Fax:425-646-3901
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:410
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3548
Practice Address - Country:US
Practice Address - Phone:206-447-1570
Practice Address - Fax:206-447-1592
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8432643Medicaid
WAP96611Medicare UPIN
WAG8856484Medicare PIN