Doctor Name: | COLLEEN BONADIES |
NPI Number: | 1053614818 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSPT |
License Number: | 004858 |
Business Practice Address: | 843 Bolton Rd Storrs, CT - 062691249 |
Business Phone Number: | 8604868080 |
Business Fax Number: | 8604868081 |
Mailing Address: | 843 Bolton Rd, STORRS |
State: | CT |
Postal Code: | 062691249 |
Phone Number: | 8604868080 |
Fax Number: | 8604868081 |
NPI Enumeration Date: | 12/15/2010 |
NPI Last Update Date: | 03/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 004858 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |