Provider Demographics
NPI:1871767681
Name:MIDDLEBROOKS, BONNIE JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JEAN
Last Name:MIDDLEBROOKS
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 1:747 VOLVO PKWY
Mailing Address - Street 2:STE 103
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1615
Mailing Address - Country:US
Mailing Address - Phone:757-420-2880
Mailing Address - Fax:757-420-8090
Practice Address - Street 1:747 VOLVO PKWY
Practice Address - Street 2:STE 103
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1615
Practice Address - Country:US
Practice Address - Phone:757-420-2880
Practice Address - Fax:757-420-8090
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA57767OtherOPTIMA HEALTH INS
VA193561OtherHEALTHKEEPERS
VA193561OtherANTHEM
VA2166605OtherALLIANCE HMO,EC,MC
VA2166605OtherMAMSI/OPT/MDIPA/ALLIANCE
VA1820904006OtherUNITED HEALTHCARE
VA592523OtherAETNA
VA2138099OtherFIRST HEALTH
VA2166605OtherALLIANCE
VA2166605OtherALLIANCE