Healthcare Provider Details

I. General information

NPI: 1215905583
Provider Name (Legal Business Name): JOHN E BONAROTI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 WILLIAM PENN HWY
MURRYSVILLE PA
15668-1887
US

IV. Provider business mailing address

4115 WILLIAM PENN HWY
MURRYSVILLE PA
15668-1887
US

V. Phone/Fax

Practice location:
  • Phone: 412-856-8060
  • Fax: 724-327-0173
Mailing address:
  • Phone: 724-327-7099
  • Fax: 724-327-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005381L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: