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General NPI Number Information
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NPI Number | 1013563170
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Entity Type | Individual
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Provider Name | LAURA BONIN DPT
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Gender | Female
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 3745 CHEROKEE ST NW STE 602
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City | KENNESAW
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State | GA
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Zip | 30144-6785
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Country | US
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Telephone | 770-558-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 1760 NORTHSIDE DR NW APT 307
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City | ATLANTA
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State | GA
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Zip | 30318-2669
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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