Provider Demographics
NPI:1265548457
Name:BONNESS, DAWN D (PT)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:D
Last Name:BONNESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:DYMACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1651 N 86TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3719
Mailing Address - Country:US
Mailing Address - Phone:402-484-7117
Mailing Address - Fax:402-484-7118
Practice Address - Street 1:6101 VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5830
Practice Address - Country:US
Practice Address - Phone:402-420-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39912OtherBCBS OF NEBRASKA
NEP00219046OtherMEDICARE (RAILROAD)
NE39912OtherBCBS OF NEBRASKA
Q03057Medicare UPIN