Provider Demographics
NPI:1780920348
Name:BONK, KRISTI JO (LMP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:JO
Last Name:BONK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 LAKEMOOR LOOP SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5535
Mailing Address - Country:US
Mailing Address - Phone:360-329-2655
Mailing Address - Fax:
Practice Address - Street 1:312 COLUMBIA ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1031
Practice Address - Country:US
Practice Address - Phone:360-357-1390
Practice Address - Fax:360-357-1391
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60305968172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist