Provider Demographics
NPI:1386755049
Name:ELSE, BONNIE B (PT)
Entity type:Individual
Prefix:PROF
First Name:BONNIE
Middle Name:B
Last Name:ELSE
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 1:15969 N ORACLE RD
Mailing Address - Street 2:SUITE 171
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9209
Mailing Address - Country:US
Mailing Address - Phone:520-293-5747
Mailing Address - Fax:520-293-5626
Practice Address - Street 1:15969 N ORACLE RD
Practice Address - Street 2:SUITE 171
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9209
Practice Address - Country:US
Practice Address - Phone:520-293-5747
Practice Address - Fax:520-293-5626
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist