Provider Demographics
NPI:1487998761
Name:BONDOC-ROAQUIN, PAULINE CARMELA (PT)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:CARMELA
Last Name:BONDOC-ROAQUIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:CARMELA
Other - Last Name:ROAQUIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:650 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8707
Mailing Address - Country:US
Mailing Address - Phone:678-312-3000
Mailing Address - Fax:
Practice Address - Street 1:650 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8707
Practice Address - Country:US
Practice Address - Phone:678-312-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist