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General NPI Number Information
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NPI Number | 1669996864
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Entity Type | Individual
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Provider Name | JONATHAN MATHEW PAUL BONNETT PTA
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Gender | Male
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 6565 FOXRIDGE DR APT 1051
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City | MISSION
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State | KS
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Zip | 66202-1393
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Country | US
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Telephone | 913-605-2528
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Fax | 913-605-2528
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Provider Business Mailing Address
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Address Line | 5007 BROADMOOR ST APT 127
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City | MISSION
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State | KS
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Zip | 66202-1462
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Country | US
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Telephone | 913-605-2528
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 197780
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1416172
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License Number State | KS
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