Active NPI
Stephanie Bonidie, PT
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1124222583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT23407
- Practice address
- 11160 Beach Blvd Ste 133
Jacksonville, FL 32246-4877 - Phone
- (904) 646-2828
- NPI assigned
- Jun 12, 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 Therapist | 225100000X | PT23407 | FL | Primary |
Addresses
Primary practice location
11160 Beach Blvd Ste 133
Jacksonville, FL 32246-4877
Mailing address
2145 W Lymington Way
St Augustine, FL 32084-1104
Phone (904) 827-1858
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 |
|---|---|---|---|
| PT23407 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124222583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2145 W LYMINGTON WAY",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320841104",
"telephone_number": "904-827-1858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11160 BEACH BLVD STE 133",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322464877",
"telephone_number": "904-646-2828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONIDIE",
"first_name": "STEPHANIE",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT23407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.