MEDICARE: RONALD A. BONNETT P.T.

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	208100000X	Physical Medicine & Rehabilitation Physician	PT0000690	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y1017	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134183296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD A. BONNETT P.T.

Provider Business Mailing Address
First Line	:	251 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-385-1406
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-385-1406
Fax Number	:

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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