Provider Demographics
NPI:1952738122
Name:DAUGHTRY, BONNY EICHELBERGER (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BONNY
Middle Name:EICHELBERGER
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MUTUAL DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1767
Mailing Address - Country:US
Mailing Address - Phone:864-261-3313
Mailing Address - Fax:864-261-3371
Practice Address - Street 1:120 MUTUAL DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1767
Practice Address - Country:US
Practice Address - Phone:864-261-3313
Practice Address - Fax:864-261-3371
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist