Provider Demographics
NPI:1770989691
Name:BONNEY, DOROTHY
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:BONNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3001
Mailing Address - Country:US
Mailing Address - Phone:856-848-4442
Mailing Address - Fax:856-848-1836
Practice Address - Street 1:1297 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3001
Practice Address - Country:US
Practice Address - Phone:856-848-4442
Practice Address - Fax:856-848-1836
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00552400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist