Provider Demographics
NPI:1609826965
Name:DAVIDSON, BONNIE JEAN (PT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:JEAN
Last Name:DAVIDSON
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 1:10 MONTEREY CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2211
Mailing Address - Country:US
Mailing Address - Phone:415-250-3231
Mailing Address - Fax:
Practice Address - Street 1:10 MONTEREY CT
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2211
Practice Address - Country:US
Practice Address - Phone:415-250-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4942225100000X
CA14985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT149850Medicare ID - Type UnspecifiedPHYSICAL THERAPY MEDICARE