Provider Demographics
NPI:1669696027
Name:BONNEMA, LISA LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:BONNEMA
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:5130 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558
Mailing Address - Country:US
Mailing Address - Phone:708-246-1836
Mailing Address - Fax:708-246-2948
Practice Address - Street 1:8236 S MADISON
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-230-9788
Practice Address - Fax:630-230-9277
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211081Medicare ID - Type UnspecifiedFOR MEDICARE B PATIENTS