Healthcare Provider Details

I. General information

NPI: 1063861722
Provider Name (Legal Business Name): BONDURANT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PAINE ST SE SUITE B
BONDURANT IA
50035-1154
US

IV. Provider business mailing address

85 PAINE ST SE STE B
BONDURANT IA
50035-1154
US

V. Phone/Fax

Practice location:
  • Phone: 515-528-2326
  • Fax: 515-528-2327
Mailing address:
  • Phone: 515-528-2326
  • Fax: 515-528-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE ROSE BRANT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 515-528-2326