Provider Demographics
NPI:1306800594
Name:BASTIAN, BONNIE (PT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 OAK RIDGE HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2345
Mailing Address - Country:US
Mailing Address - Phone:865-313-2445
Mailing Address - Fax:865-313-2455
Practice Address - Street 1:709 S CONCORD ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3309
Practice Address - Country:US
Practice Address - Phone:865-637-2321
Practice Address - Fax:865-637-4664
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NH1022225100000X
TN16078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE 4118Medicare ID - Type UnspecifiedPHYSICAL THERAPY