Provider Demographics
NPI:1417753898
Name:BONDS, THOMAS MARTIN I
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARTIN
Last Name:BONDS
Suffix:I
Gender:
Credentials:
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:M
Other - Last Name:BONDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3731
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-3731
Mailing Address - Country:US
Mailing Address - Phone:863-412-9702
Mailing Address - Fax:
Practice Address - Street 1:2202 BOUYER ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-8552
Practice Address - Country:US
Practice Address - Phone:863-412-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home