Provider Demographics
NPI:1528316734
Name:WALPERT, BONNIE (PT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:WALPERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:WALPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1498 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6120
Mailing Address - Country:US
Mailing Address - Phone:503-697-1887
Mailing Address - Fax:
Practice Address - Street 1:1498 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-6120
Practice Address - Country:US
Practice Address - Phone:503-697-1887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist