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General NPI Number Information
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NPI Number | 1558217380
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Entity Type | Individual
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Provider Name | KYLE BONACQUISTI DPT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 2426 GARFIELD AVE
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City | CARMICHAEL
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State | CA
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Zip | 95608-5199
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Country | US
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Telephone | 916-488-5722
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Fax |
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Provider Business Mailing Address
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Address Line | 8588 MISSION FALLS CIR
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City | ELK GROVE
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State | CA
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Zip | 95624-3940
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Country | US
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Telephone | 916-217-7628
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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 | 309845
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License Number State | CA
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