Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1073715280 |
---|---|
Provider Name | Ms. Stephanie Bono |
First Address | Braintree, MA 02184-4301 |
Second Address | Braintree, MA 02184 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 20/01/2016 |