Provider Demographics
NPI:1649377060
Name:AHARONIAN, BONNIE JEAN (PTA)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN
Last Name:AHARONIAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEANE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6352
Mailing Address - Country:US
Mailing Address - Phone:802-865-0211
Mailing Address - Fax:
Practice Address - Street 1:790 COLLEGE PARKWAY
Practice Address - Street 2:FAHC FANNY ALLEN CAMPUS
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446
Practice Address - Country:US
Practice Address - Phone:802-847-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0410000419225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant