Active NPI
Bonnie Lyn Waldron, PTA
- Physical Therapy Assistant
- Gardner, MA
National Provider Identifier
1104025766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 648
- Practice address
- 32 Hospital Hill Rd
Gardner, MA 01440-2302 - Phone
- (978) 632-5477
- NPI assigned
- Jul 13, 2007
- Last updated
- Jul 13, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 648 | MA | Primary |
Addresses
Primary practice location
32 Hospital Hill Rd
Gardner, MA 01440-2302
Mailing address
15 Rollingwoods Rd
Hubbardston, MA 01452-1310
Phone (978) 928-4782
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 648 | Other | MA | PTA LICENSE SERIAL NUMBER |
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 |
|---|---|---|---|
| 648 | MA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184284800000",
"number": "1104025766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 ROLLINGWOODS RD",
"city": "HUBBARDSTON",
"state": "MA",
"postal_code": "014521310",
"telephone_number": "978-928-4782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "32 HOSPITAL HILL RD",
"city": "GARDNER",
"state": "MA",
"postal_code": "014402302",
"telephone_number": "978-632-5477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDRON",
"first_name": "BONNIE",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-13",
"last_updated": "2007-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "648",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE SERIAL NUMBER",
"identifier": "648",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gardner, MA
- Huy Duc Vu, RPH
- Wachusett Radiology, Inc.
- Wachusett Rehabilitation and Nursing Center LLC
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2155)
- Wal-Mart Stores East, LP (Wal-Mart Vision Center 30-2155)
- Joseph W Walek, MD
- Walgreen Co (Walgreens #17230)
- Walgreen Co (Walgreens #17177)
- Barbara J. Walker, RNNP
- Bonnie Jean Wallace, MED
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.