Provider Demographics
NPI:1336620871
Name:BONDS, KENYON YAR'MAUDE (PTA)
Entity Type:Individual
Prefix:
First Name:KENYON
Middle Name:YAR'MAUDE
Last Name:BONDS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 BISHOP BARREL LN
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0228
Mailing Address - Country:US
Mailing Address - Phone:405-638-5587
Mailing Address - Fax:
Practice Address - Street 1:8300 EL DORADO PKWY WEST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:972-548-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111781225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant