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General NPI Number Information
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NPI Number | 1447027248
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Entity Type | Individual
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Provider Name | COURTNEY ELIZABETH BONNER
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 45900 GEDDES RD
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City | CANTON
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State | MI
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Zip | 48188-2306
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Country | US
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Telephone | 734-879-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 57 E FOREST AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-2832
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Country | US
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Telephone | 734-330-9049
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502004744
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License Number State | MI
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