Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 004858 | CT |
NPI | 1053614818 |
---|---|
Provider Name | Colleen Bonadies |
First Address | Storrs, CT 06269-1249 |
Second Address | Storrs, CT 06269-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2010 |
Last Update Date | 18/03/2015 |