Provider Demographics
NPI:1154410785
Name:EASLEY, BONNIE ANNE (PTA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ANNE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:ANNE
Other - Last Name:QUAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:527 21ST ST # 69
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2629 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5769
Practice Address - Country:US
Practice Address - Phone:239-574-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
FLPTA31081225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant