Provider Demographics
NPI:1194117234
Name:BONASTIA, BAILEE (DPT)
Entity type:Individual
Prefix:DR
First Name:BAILEE
Middle Name:
Last Name:BONASTIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16617 WYCLIFFE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-6635
Mailing Address - Country:US
Mailing Address - Phone:636-675-0091
Mailing Address - Fax:
Practice Address - Street 1:16617 WYCLIFFE PLACE DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63005-6635
Practice Address - Country:US
Practice Address - Phone:636-675-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist