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NPI Code Detail

MEDICARE: BONNIE ANNE EASLEY PTA

MEDICARE: BONNIE ANNE EASLEY PTA
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
1225200000XPhysical Therapy Assistant
2225200000XPhysical Therapy AssistantPTA31081FL

General Provider Information

NPI Number : 1154410785
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE ANNE EASLEY PTA
Provider Business Mailing Address
First Line : 527 21ST ST # 69
Second Line :
City : GALVESTON
State : TX
Zip : 77550-2017
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2629 DEL PRADO BLVD S
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-5769
Country : US
Telephone Number : 239-574-4434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 05/04/2021

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