Provider Demographics
NPI:1134183296
Name:BONNETT, RONALD A (PT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:BONNETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2146
Mailing Address - Country:US
Mailing Address - Phone:863-385-1406
Mailing Address - Fax:
Practice Address - Street 1:251 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2146
Practice Address - Country:US
Practice Address - Phone:863-385-1406
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0000690208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY1017OtherBLUE CROSS BLUE SHIELD
FLY1017OtherBLUE CROSS BLUE SHIELD