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General NPI Number Information
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NPI Number | 1790526424
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Entity Type | Individual
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Provider Name | ALEXANDER NATHAN BONGERS DPT
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Gender | Male
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 87 FENTON ST STE 106
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City | LIVERMORE
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State | CA
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Zip | 94550-4159
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Country | US
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Telephone | 925-373-9394
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Fax |
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Provider Business Mailing Address
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Address Line | 12447 150TH ST E
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City | NERSTRAND
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State | MN
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Zip | 55053-2233
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Country | US
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Telephone | 507-649-7832
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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 | 16792-24
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License Number State | WI
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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 | 306179
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License Number State | CA
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