MEDICARE: MR. JAMES C BONARDI MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01022800	NJ

General Provider Information

NPI Number	:	1023063120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES C BONARDI MPT

Provider Business Mailing Address
First Line	:	180 CORABELLE AVE
Second Line	:	SUITE ONE
City	:	LODI
State	:	NJ
Zip	:	07644-1706
Country	:	US
Telephone Number	:	973-405-6464
Fax Number	:	973-405-6846

Provider Business Practice Location Address
First Line	:	1 S MAIN ST
Second Line	:	SUITE ONE
City	:	LODI
State	:	NJ
Zip	:	07644-2240
Country	:	US
Telephone Number	:	973-405-6464
Fax Number	:	973-405-6846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	09/22/2009

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