Provider Demographics
NPI:1295934628
Name:BEYER, BONNIE K (PT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:K
Last Name:BEYER
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 1:2047 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4602
Mailing Address - Country:US
Mailing Address - Phone:262-551-9400
Mailing Address - Fax:262-551-9416
Practice Address - Street 1:2047 22ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4602
Practice Address - Country:US
Practice Address - Phone:262-551-9400
Practice Address - Fax:262-551-9416
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2008-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1519-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391313084017OtherANTHEM BLUE SHIELD
WI1519-024OtherPT LICENSE
WI40014000Medicaid
WIR97942Medicare UPIN