Provider Demographics
NPI:1215285150
Name:SOTO, BONNIE LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:SOTO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LYNN
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:163 THOMAS JOHNSON DR STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4673
Mailing Address - Country:US
Mailing Address - Phone:240-566-3187
Mailing Address - Fax:
Practice Address - Street 1:194 THOMAS JOHNSON DR STE B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4683
Practice Address - Country:US
Practice Address - Phone:301-418-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZ99842251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12614874OtherCAQH