Basic Information
| Provider Information | |||||||||
| NPI: | 1871797357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOND | ||||||||
| FirstName: | THERONICA | ||||||||
| MiddleName: | ROOSETTA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 678625 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172849850 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 MATLOCK RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174684000 | ||||||||
| FaxNumber: | 8172843425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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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 | 208100000X | M7865 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 8AW000 | 01 | TX | BLUECROSS BLUESHIELD OF TEXAS | OTHER | BP3-0018732 | 01 | INSTITUTIONAL PERMIT | OTHER |