Provider Demographics
NPI:1649706409
Name:BONNER, KATHLEEN (PT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:BONNER
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 1:1011 HOFFMAN CANAL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-2820
Mailing Address - Country:US
Mailing Address - Phone:609-408-8532
Mailing Address - Fax:
Practice Address - Street 1:3860 BAYSHORE RD STE F
Practice Address - Street 2:
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3267
Practice Address - Country:US
Practice Address - Phone:609-770-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00502400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist