MEDICARE: KYLE BONACQUISTI 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	309845	CA

General Provider Information

NPI Number	:	1558217380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE BONACQUISTI DPT

Provider Business Mailing Address
First Line	:	8588 MISSION FALLS CIR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-3940
Country	:	US
Telephone Number	:	916-217-7628
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 GARFIELD AVE
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-5199
Country	:	US
Telephone Number	:	916-488-5722
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ KYLE BONACQUISTI DPT” Practice Location

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