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General NPI Number Information
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NPI Number | 1306800594
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Entity Type | Individual
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Provider Name | BONNIE BASTIAN PT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 709 S CONCORD ST
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City | KNOXVILLE
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State | TN
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Zip | 37919-3309
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Country | US
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Telephone | 865-637-2321
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Fax | 865-637-4664
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Provider Business Mailing Address
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Address Line | 7811 OAK RIDGE HWY STE 3
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City | KNOXVILLE
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State | TN
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Zip | 37931-2345
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Country | US
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Telephone | 865-313-2445
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Fax | 865-313-2455
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1022
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16078
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License Number State | TN
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