NPIMap

Organization Active NPI

Bonner Physical Therapy P.C.

  • Physical Therapist
  • Sandpoint, ID
National Provider Identifier
1053461533
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-094 Issued in ID
Legal business name
BONNER PHYSICAL THERAPY P.C.
Practice address
1327 Superior St
Sandpoint, ID 83864-1735
Phone
(208) 263-5731
Fax
(208) 265-4716
NPI assigned
Jan 10, 2007
Last updated
May 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

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

Authorized official

Name
Mr. Steven A SodorffNPI 1609958701
Title
PT
Phone
(208) 263-5731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-094 ID Primary

Addresses

Primary practice location

1327 Superior St
Sandpoint, ID 83864-1735

Mailing address

1327 Superior St
Sandpoint, ID 83864-1735
Phone (208) 263-5731

Other identifiers 2

IdentifierTypeStateIssuer
000010008010OtherIDREGENCE BLUE SHIELD
T0049OtherIDBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1053461533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 SUPERIOR ST",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641735",
            "telephone_number": "208-263-5731",
            "fax_number": "208-265-4716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 SUPERIOR ST",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641735",
            "telephone_number": "208-263-5731",
            "fax_number": "208-265-4716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNER PHYSICAL THERAPY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2011-05-19",
        "status": "A",
        "authorized_official_last_name": "SODORFF",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "208-263-5731",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010008010",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "T0049",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandpoint, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.