Provider Demographics
NPI:1972035830
Name:IHDE, BONNIE Y (DPT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:Y
Last Name:IHDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:Y
Other - Last Name:IM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10700 CHARTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3631
Mailing Address - Country:US
Mailing Address - Phone:410-992-7800
Mailing Address - Fax:410-720-2190
Practice Address - Street 1:10700 CHARTER DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3631
Practice Address - Country:US
Practice Address - Phone:410-992-7800
Practice Address - Fax:410-720-2190
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist