Basic Information
| Provider Information | |||||||||
| NPI: | 1114025418 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENNIS JAMES BONNER, MD, LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INDUSTRIAL HEALTH CARE, CENTER FOR REHAB AND FITNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 S STATE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155796991 | ||||||||
| FaxNumber: | 2155799774 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 S STATE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155796991 | ||||||||
| FaxNumber: | 2155799774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FREDERICK | ||||||||
| AuthorizedOfficialFirstName: | MAUREEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRINCIPLE | ||||||||
| AuthorizedOfficialTelephone: | 2156770930 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA052018-LPA | PA | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 225100000X | PT005508L | PA | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT008212-L | PA | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.