Matt Bonander LLC
Organization Active NPI Physical Therapist · Krum, TX
NPI 1154074201 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1154074201
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 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
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew Ellis Bonander, PT, DPT
- Title
- Physical Therapist
- Phone
- (940) 535-8105
Practitioners 14
-
David Barnes, OT
-
Tamara Williard, SLP,MA,CCC-SLP
-
Joshua Webb, OTD
-
Deanna Marie Burks, OTRL
-
Holly Dollar, MOT, OTR
-
Kristi M Rosado, PT, DPT
-
Cynthia Castle Weathers, CCC/SLP
-
Jennifer Maraga, OTR
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
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
Other providers in Krum, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.