Provider Demographics
NPI:1275976318
Name:HOLLAND, BONNIE (PT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 SE 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1804
Mailing Address - Country:US
Mailing Address - Phone:971-220-5009
Mailing Address - Fax:971-373-8055
Practice Address - Street 1:3028 SE 71ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1804
Practice Address - Country:US
Practice Address - Phone:971-220-5009
Practice Address - Fax:971-373-8055
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist