Basic Information
| Provider Information | |||||||||
| NPI: | 1225099732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONI | ||||||||
| FirstName: | GUERRINO | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1181 AQUIDNECK AVE | ||||||||
| Address2: | OLYMPIC PHYSICAL THERAPY | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018450840 | ||||||||
| FaxNumber: | 4018450842 | ||||||||
| Practice Location | |||||||||
| Address1: | 1181 AQUIDNECK AVE | ||||||||
| Address2: | OLYMPIC PHYSICAL THERAPY | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018450840 | ||||||||
| FaxNumber: | 4018450842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1838 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.