Healthcare Provider Details

I. General information

NPI: 1386901940
Provider Name (Legal Business Name): BONNIE ELIZABETH BARRON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 N HARDING AVE
PASADENA CA
91104-1940
US

IV. Provider business mailing address

PO BOX 264
SIERRA MADRE CA
91025-0264
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-1224
  • Fax: 626-794-1224
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT1834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: