Steven Bonham, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA2173AR Issued in AR

Practice address

385 Nail Rd
Apt B-21
Southaven, MS 38671-8853

Phone

(870) 897-9503

NPI assigned

Jul 17, 2008

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 17, 2008.

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216252800000",
    "number": "1093979148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 NAIL RD",
            "address_2": "APT B-21",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386718853",
            "telephone_number": "870-897-9503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 NAIL RD",
            "address_2": "APT B-21",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386718853",
            "telephone_number": "870-897-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONHAM",
        "first_name": "STEVEN",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-17",
        "last_updated": "2008-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA2173AR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Southaven, MS
• Physical Therapy Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; 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.