Basic Information
| Provider Information | |||||||||
| NPI: | 1750462255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLATT | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2408 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034073500 | ||||||||
| FaxNumber: | 2032811164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 YALE AVE | ||||||||
| Address2: | |||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032940449 | ||||||||
| FaxNumber: | 2032848271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 003156 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.