Provider Demographics
NPI:1609622877
Name:BONNER-WARSZAWSKI, ELIA CHARLAYNE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIA
Middle Name:CHARLAYNE
Last Name:BONNER-WARSZAWSKI
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 1:28208 REY DE COPAS LN
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4461
Mailing Address - Country:US
Mailing Address - Phone:310-801-2614
Mailing Address - Fax:
Practice Address - Street 1:28208 REY DE COPAS LN
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4461
Practice Address - Country:US
Practice Address - Phone:310-801-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28523225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist