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General NPI Number Information
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NPI Number | 1952068306
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Entity Type | Individual
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Provider Name | CARL JOSEPH BONANNO
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Gender | Male
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 11301 N 99TH AVE
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City | PEORIA
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State | AZ
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Zip | 85345-5466
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Country | US
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Telephone | 623-977-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 10714 W WELK DR
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City | SUN CITY
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State | AZ
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Zip | 85373-1841
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Country | US
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Telephone | 623-330-3502
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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 |
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License Number State | AZ
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