Provider Demographics
NPI:1124095088
Name:PHILLIPS, BONNIE LYNN (MPT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BUTTERNUT CT
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2506
Mailing Address - Country:US
Mailing Address - Phone:609-261-3428
Mailing Address - Fax:609-265-8331
Practice Address - Street 1:10 E STOW RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3133
Practice Address - Country:US
Practice Address - Phone:856-552-1300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00555300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist