MEDICARE: MS. KATHLEEN BONNER PT

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	40QA00502400	NJ

General Provider Information

NPI Number	:	1649706409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN BONNER PT

Provider Business Mailing Address
First Line	:	1011 HOFFMAN CANAL AVE
Second Line	:
City	:	NORTH WILDWOOD
State	:	NJ
Zip	:	08260-2820
Country	:	US
Telephone Number	:	609-408-8532
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 BAYSHORE RD STE F
Second Line	:
City	:	NORTH CAPE MAY
State	:	NJ
Zip	:	08204-3267
Country	:	US
Telephone Number	:	609-770-7804
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	01/14/2025

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