Provider Demographics
NPI:1629873039
Name:BONNICI, LAURA (PT,DPT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BONNICI
Suffix:
Gender:
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13150 HADLEY ST APT 1927
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-5158
Mailing Address - Country:US
Mailing Address - Phone:586-329-8971
Mailing Address - Fax:
Practice Address - Street 1:12213 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1273
Practice Address - Country:US
Practice Address - Phone:586-329-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023031909225100000X
KS11-06973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist