Active NPI
Teresa Lyn Bonawitz, LMP
- Mechanotherapist
- Vancouver, WA
National Provider Identifier
1063731867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- MA60042214
- Practice address
- 9104 NE Highway 99
Vancouver, WA 98665-8925 - Phone
- (360) 773-5073
- NPI assigned
- May 19, 2010
- Last updated
- May 19, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | MA60042214 | WA | Primary |
Addresses
Primary practice location
9104 NE Highway 99
Vancouver, WA 98665-8925
Mailing address
13306 NE 92ND St
Vancouver, WA 98682-3051
Phone (360) 260-0082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA60042214 | WA | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274227200000",
"number": "1063731867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13306 NE 92ND ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986823051",
"telephone_number": "360-260-0082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9104 NE HIGHWAY 99",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986658925",
"telephone_number": "360-773-5073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONAWITZ",
"first_name": "TERESA",
"middle_name": "LYN",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-19",
"last_updated": "2010-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "WA",
"license": "MA60042214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.