Provider Demographics
NPI:1831842954
Name:BONDOC, MELISSA ALEGRE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ALEGRE
Last Name:BONDOC
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 1:323 TRINITY RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0474
Mailing Address - Country:US
Mailing Address - Phone:912-245-6211
Mailing Address - Fax:
Practice Address - Street 1:323 TRINITY RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-0474
Practice Address - Country:US
Practice Address - Phone:912-245-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist