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NPI Code Detail

MEDICARE: MRS. THERESA BONIFANT PTA

MEDICARE: MRS. THERESA BONIFANT PTA
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
1225200000XPhysical Therapy Assistant1583NE

General Provider Information

NPI Number : 1669157699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA BONIFANT PTA
Provider Business Mailing Address
First Line : 488 L RD
Second Line :
City : PALMYRA
State : NE
Zip : 68418-4075
Country : US
Telephone Number : 402-432-4358
Fax Number :
Provider Business Practice Location Address
First Line : 1750 S 20TH ST
Second Line :
City : LINCOLN
State : NE
Zip : 68502-2611
Country : US
Telephone Number : 402-475-6791
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2023
Last Update Date : 06/19/2023

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Directions to “ MRS. THERESA BONIFANT PTA” Practice Location

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