Provider Demographics
NPI:1205530979
Name:BONNER, ANTHONY (WSI)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BONNER
Suffix:
Gender:M
Credentials:WSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307A CLINT ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6314
Mailing Address - Country:US
Mailing Address - Phone:214-836-7792
Mailing Address - Fax:
Practice Address - Street 1:1307A CLINT ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6314
Practice Address - Country:US
Practice Address - Phone:214-836-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOOKBDCV273Y00000X, 252Y00000X
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No273Y00000XHospital UnitsRehabilitation Unit
No252Y00000XAgenciesEarly Intervention Provider Agency