Jacqueline Bonomo, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10200 Issued in SC

Practice address

380 Long Cove Dr
Hilton Head, SC 29928-6143

Phone

(843) 645-2668

Fax

(667) 887-7789

NPI assigned

Nov 9, 2006

Last updated

Jun 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympia Innovations LLCGroup PAC ID 0244688604, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Olympia Innovations LLC

  dba Fyzical Therapy & Balance Center

  • Physical Therapy Clinic/Center
  • Bluffton, SC
  • NPI 1053010298

  Physical Therapist

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592179200000",
    "number": "1023188745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 LONG COVE DR",
            "city": "HILTON HEAD",
            "state": "SC",
            "postal_code": "299286143",
            "telephone_number": "843-645-2668",
            "fax_number": "866-788-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 LONG COVE DR",
            "city": "HILTON HEAD",
            "state": "SC",
            "postal_code": "299286143",
            "telephone_number": "843-645-2668",
            "fax_number": "667-887-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONOMO",
        "first_name": "JACQUELINE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "10200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Becky Peters Counseling, LLC
• Louis D Bell, MD
• Shelisa Benson
• Thomas J Berrigan, M.D.
• Rowan Blackmon, LPC
• Tracy E Brande, M.S.
• Michelle Suzanne Brinker, PT
• Broad River Primary Care LLC (Infectious Disease Associates of the Low Country)
• David A Brosman, MD
• Aldric Demond Browne

• Physical Therapist in Hilton Head, SC
• Providers in Hilton Head, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.