MEDICARE: MR. ROBERTO M. BONNEVIE JR. 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	225100000X	Physical Therapist	18452	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588891584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERTO M. BONNEVIE JR. P.T.

Provider Business Mailing Address
First Line	:	11325 PEMBROOKE SQ STE 115
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4807
Country	:	US
Telephone Number	:	301-719-1146
Fax Number	:	301-645-5343

Provider Business Practice Location Address
First Line	:	11325 PEMBROOKE SQ STE 115
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4807
Country	:	US
Telephone Number	:	301-358-6155
Fax Number	:

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

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	12/21/2023

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Directions to “ MR. ROBERTO M. BONNEVIE JR. P.T.” Practice Location

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