Provider Demographics
NPI:1265792956
Name:BONN, PAUL ANGELO (MPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANGELO
Last Name:BONN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 YORKFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4318
Mailing Address - Country:US
Mailing Address - Phone:818-292-0949
Mailing Address - Fax:
Practice Address - Street 1:4401 YORKFIELD CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4318
Practice Address - Country:US
Practice Address - Phone:818-292-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist