Provider Demographics
NPI:1942672357
Name:BONAT, REBECCA (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BONAT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-2437
Mailing Address - Country:US
Mailing Address - Phone:951-966-2734
Mailing Address - Fax:
Practice Address - Street 1:3572 ACACIA AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-2437
Practice Address - Country:US
Practice Address - Phone:951-966-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6667225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant