Provider Demographics
NPI:1669996864
Name:BONNETT, JONATHAN MATHEW PAUL (PTA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MATHEW PAUL
Last Name:BONNETT
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 1:5007 BROADMOOR ST APT 127
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1462
Mailing Address - Country:US
Mailing Address - Phone:913-605-2528
Mailing Address - Fax:
Practice Address - Street 1:6565 FOXRIDGE DR APT 1051
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1393
Practice Address - Country:US
Practice Address - Phone:913-605-2528
Practice Address - Fax:913-605-2528
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS197780376K00000X
KS1416172225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS197780OtherNURSE AIDE REGISTRY