Healthcare Provider Details

I. General information

NPI: 1578928065
Provider Name (Legal Business Name): CHRISTOPHER BONNELL M.ED, AT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS BONNELL M.ED, AT, ATC

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 CORNELL RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

4545 TREEVIEW CT
BATAVIA OH
45103-4300
US

V. Phone/Fax

Practice location:
  • Phone: 513-686-1770
  • Fax:
Mailing address:
  • Phone: 513-735-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT. 002844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: