MEDICARE: DANIEL MARK BONAROTI 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	6092	AZ

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	:	1740367978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MARK BONAROTI PT

Provider Business Mailing Address
First Line	:	5017 E WASHINGTON ST STE 107
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2033
Country	:	US
Telephone Number	:	602-277-1073
Fax Number	:	602-277-1016

Provider Business Practice Location Address
First Line	:	5017 E WASHINGTON ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-2033
Country	:	US
Telephone Number	:	602-277-1073
Fax Number	:	602-277-1016

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/17/2025

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