Provider Demographics
NPI:1306800594
Name:BASTIAN, BONNIE (PT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-0421
Mailing Address - Country:US
Mailing Address - Phone:603-497-8717
Mailing Address - Fax:603-497-8711
Practice Address - Street 1:48 MAST RD
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2350
Practice Address - Country:US
Practice Address - Phone:603-497-8717
Practice Address - Fax:603-497-8711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE 4118Medicare ID - Type UnspecifiedPHYSICAL THERAPY