Provider Demographics
NPI:1790526424
Name:BONGERS, ALEXANDER NATHAN (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NATHAN
Last Name:BONGERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12447 150TH ST E
Mailing Address - Street 2:
Mailing Address - City:NERSTRAND
Mailing Address - State:MN
Mailing Address - Zip Code:55053-2233
Mailing Address - Country:US
Mailing Address - Phone:507-649-7832
Mailing Address - Fax:
Practice Address - Street 1:87 FENTON ST STE 106
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4159
Practice Address - Country:US
Practice Address - Phone:925-373-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16792-24225100000X
CA306179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist