Provider Demographics
NPI:1316164346
Name:BONANNI, MAUREEN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:BONANNI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3656
Mailing Address - Country:US
Mailing Address - Phone:856-220-0540
Mailing Address - Fax:
Practice Address - Street 1:1030 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1907
Practice Address - Country:US
Practice Address - Phone:856-321-1900
Practice Address - Fax:856-321-1107
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00436100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist