MEDICARE: MS. BONITA LYNN DESPAIN 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
1	225100000X	Physical Therapist	2015026804	MO
2	225200000X	Physical Therapy Assistant	160.005650	IL
3	225200000X	Physical Therapy Assistant	A2779	MN

General Provider Information

NPI Number	:	1588033658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BONITA LYNN DESPAIN PTA

Provider Business Mailing Address
First Line	:	422 7TH ST # 1
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2619
Country	:	US
Telephone Number	:	309-502-1408
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 KEENAN DR
Second Line	:
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2152
Country	:	US
Telephone Number	:	218-283-8313
Fax Number	:

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

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	05/25/2022

Similar Medicare Providers

1447337068 — STEPHANIE GANSCHOW PHARMD
Practice Location Address:

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

1427033810 — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Practice Location Address:

2201 KEENAN DR
INTERNATIONAL FALLS, MN
56649-2152

Practice Phone: 218-283-8313
Practice Fax: 218-283-9497

1386695443 — THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Practice Location Address:

2221 KEENAN DR
INTERNATIONAL FALLS, MN
56649-2152

Practice Phone: 308-928-2128
Practice Fax:

1124480181 — JENNY SKOOG PTA
Practice Location Address:

2201 KEENAN DR
INTERNATIONAL FALLS, MN
56649-2152

Practice Phone: 218-283-8313
Practice Fax:

1669045753 — CASSIE THOMPSON OTR/L
Practice Location Address:

2201 KEENAN DR
INTERNATIONAL FALLS, MN
56649-2152

Practice Phone: 218-283-1310
Practice Fax:

1659755130 — DR. GREGARY R BOEHME DMD
Practice Location Address:

2152 VILLAGE PARK AVE
TWIN FALLS, ID
83301-4172

Practice Phone: 208-735-5599
Practice Fax: 208-735-5597

Directions to “ MS. BONITA LYNN DESPAIN PTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.