NPIMap

Organization Active NPI

Matt Bonander LLC

  • Physical Therapist
  • Krum, TX
National Provider Identifier
1154074201
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MATT BONANDER LLC
Practice address
4118 Herdsman Dr
Krum, TX 76249-1556
Phone
(940) 535-8105
NPI assigned
Jan 29, 2022
Last updated
Oct 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Dr. Matthew Ellis Bonander, PT, DPTNPI 1619119831
Title
Physical Therapist
Phone
(940) 535-8105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

4118 Herdsman Dr
Krum, TX 76249-1556

Mailing address

4118 Herdsman Dr
Krum, TX 76249-1556
Phone (940) 535-8105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220315001306 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3274928023 Receives reassigned benefits from 14 practitioners
Practice locations: Krum, TX; Little Elm, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1643414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1154074201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4118 HERDSMAN DR",
            "city": "KRUM",
            "state": "TX",
            "postal_code": "762491556",
            "telephone_number": "940-535-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4118 HERDSMAN DR",
            "city": "KRUM",
            "state": "TX",
            "postal_code": "762491556",
            "telephone_number": "940-535-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT BONANDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-29",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "BONANDER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "ELLIS",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "940-535-8105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Krum, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.