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General NPI Number Information
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NPI Number | 1285772475
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Entity Type | Individual
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Provider Name | DOUGLAS ANDREW BONNESEN P.T.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9727 E SHANNON WOODS CIR STE 160
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City | WICHITA
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State | KS
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Zip | 67226-4102
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Country | US
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Telephone | 316-681-0824
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Fax | 316-219-1349
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Provider Business Mailing Address
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Address Line | 6407 E 39TH CT N
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City | WICHITA
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State | KS
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Zip | 67226-2455
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Country | US
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Telephone | 316-687-9240
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-01966
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License Number State | KS
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