Provider Demographics
NPI:1144299371
Name:BONAR, GEOFFREY P (RPT)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:P
Last Name:BONAR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6021
Mailing Address - Country:US
Mailing Address - Phone:605-399-9565
Mailing Address - Fax:605-399-9584
Practice Address - Street 1:4141 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6021
Practice Address - Country:US
Practice Address - Phone:605-399-9565
Practice Address - Fax:605-399-9584
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0309OtherDAKOTACARE
SD0003359OtherWELLMARK
SD23297OtherSANFORD HEALTH
SD5831220Medicaid
SD650011998Medicare PIN
SD5831220Medicaid