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General NPI Number Information
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NPI Number | 1285253963
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Entity Type | Individual
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Provider Name | CHRISTINA ELIZABETH BONA ATC
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Gender | Female
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 150 POQUONOCK AVE
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City | WINDSOR
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State | CT
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Zip | 06095-2429
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Country | US
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Telephone | 860-688-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 205 VERNON AVE APT 226
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City | VERNON
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State | CT
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Zip | 06066-4346
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Country | US
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Telephone | 573-528-9189
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001286
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License Number State | CT
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