Provider Demographics
NPI:1154763076
Name:HOSTETLER, BONNIE ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ELIZABETH
Last Name:HOSTETLER
Suffix:
Gender:F
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 1:2412 STRATTON DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6229
Mailing Address - Country:US
Mailing Address - Phone:240-328-3929
Mailing Address - Fax:
Practice Address - Street 1:2412 STRATTON DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6229
Practice Address - Country:US
Practice Address - Phone:240-328-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010894225100000X
COPTL.0011844225100000X
SC6783225100000X
TN9454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist