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General NPI Number Information
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NPI Number | 1053461533
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Entity Type | Organization
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Legal Business Name | BONNER PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 1327 SUPERIOR ST
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City | SANDPOINT
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State | ID
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Zip | 83864-1735
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Country | US
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Telephone | 208-263-5731
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Fax | 208-265-4716
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Provider Business Mailing Address
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Address Line | 1327 SUPERIOR ST
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City | SANDPOINT
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State | ID
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Zip | 83864-1735
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Country | US
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Telephone | 208-263-5731
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Fax | 208-265-4716
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Authorized Official
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Title or Position | PT
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Name | MR. STEVEN A SODORFF
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Credential |
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Telephone | 208-263-5731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-094
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License Number State | ID
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