Healthcare Provider Details

I. General information

NPI: 1053065953
Provider Name (Legal Business Name): EDISON ABADIA BONO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

99 N MAIN ST APT 2
WEST LEBANON NH
03784-1109
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5632
  • Fax:
Mailing address:
  • Phone: 603-359-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: