Provider Demographics
NPI:1609101104
Name:BONDURANT, ASHLEY R (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:BONDURANT
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 1:4257 SEBAGO RD
Mailing Address - Street 2:
Mailing Address - City:MEGGETT
Mailing Address - State:SC
Mailing Address - Zip Code:29449-6034
Mailing Address - Country:US
Mailing Address - Phone:410-603-0534
Mailing Address - Fax:
Practice Address - Street 1:4257 SEBAGO RD
Practice Address - Street 2:
Practice Address - City:MEGGETT
Practice Address - State:SC
Practice Address - Zip Code:29449-6034
Practice Address - Country:US
Practice Address - Phone:410-603-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7438225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7438OtherPT LICENSE
SC7438OtherPT LICENSE