Provider Demographics
NPI:1174558837
Name:MCLAUGHLIN, BONNIE CHRISTINE (MSPT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:CHRISTINE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 JEFFRIES WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4323
Mailing Address - Country:US
Mailing Address - Phone:804-464-1256
Mailing Address - Fax:
Practice Address - Street 1:9101 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5022
Practice Address - Country:US
Practice Address - Phone:804-272-9192
Practice Address - Fax:804-272-9257
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00258156OtherRAILROAD MEDICARE
VA139046OtherBC/BS
VA395862OtherMAMSI
VA139046OtherBC/BS