MEDICARE: MANISH BONDALE 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	5501006930	MI
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30069	OTHER		BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972533016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISH BONDALE PT

Provider Business Mailing Address
First Line	:	1500 W. HIGH ST
Second Line	:
City	:	MT. PLEASANT
State	:	MI
Zip	:	48858
Country	:	US
Telephone Number	:	989-772-0258
Fax Number	:	989-953-4603

Provider Business Practice Location Address
First Line	:	1500 W. HIGH ST.
Second Line	:
City	:	MT. PLEASANT
State	:	MI
Zip	:	48858
Country	:	US
Telephone Number	:	989-772-0258
Fax Number	:	989-953-4603

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	03/19/2010

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Directions to “ MANISH BONDALE PT” Practice Location

Language	Start Address	Practice Location

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