Provider Demographics
NPI:1871811182
Name:ELLIS, BONNIE F (PT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:F
Last Name:ELLIS
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 1:429 WHITEHILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST RYEGATE
Mailing Address - State:VT
Mailing Address - Zip Code:05042-8934
Mailing Address - Country:US
Mailing Address - Phone:802-633-3580
Mailing Address - Fax:
Practice Address - Street 1:600 SAINT JOHNSBURY RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3442
Practice Address - Country:US
Practice Address - Phone:603-444-9530
Practice Address - Fax:603-944-9361
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist