Provider Demographics
NPI:1912309600
Name:BONNAND, SUSAN E (PTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:BONNAND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7878 N WILDING DR #36
Mailing Address - Street 2:
Mailing Address - City:SPOAKNE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:406-209-1232
Mailing Address - Fax:
Practice Address - Street 1:7878 N WILDING DR APT 36
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5591
Practice Address - Country:US
Practice Address - Phone:406-209-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-7680225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant