Provider Demographics
NPI:1487743720
Name:CHRISTENSEN, BONITA ANNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BONITA
Middle Name:ANNE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SCHOLL CT
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1440
Mailing Address - Country:US
Mailing Address - Phone:715-268-7107
Mailing Address - Fax:715-268-6167
Practice Address - Street 1:220 SCHOLL CT
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1440
Practice Address - Country:US
Practice Address - Phone:715-268-7107
Practice Address - Fax:715-268-6167
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI734019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40387000Medicaid