MEDICARE: SEATON BONAR DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	31863	AZ

General Provider Information

NPI Number	:	1093387045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEATON BONAR DPT

Provider Business Mailing Address
First Line	:	1076 W CHANDLER BLVD
Second Line	:	STE 103
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5223
Country	:	US
Telephone Number	:	480-821-1997
Fax Number	:	480-821-2536

Provider Business Practice Location Address
First Line	:	6630 W CACTUS RD STE B112
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1662
Country	:	US
Telephone Number	:	623-469-5811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2021
Last Update Date	:	07/14/2021

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Directions to “ SEATON BONAR DPT” Practice Location

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