Active NPI
Deva Bonnel
- Physical Therapist
- Lawrence, KS
National Provider Identifier
1164822003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1104830
- Practice address
- 1112 W 6TH St
Suite 124
Lawrence, KS 66044-2215 - Phone
- (785) 843-9125
- Fax
- (785) 843-0032
- NPI assigned
- Aug 28, 2014
- Sex
- Male
- 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 | 1104830 | KS | Primary |
Addresses
Primary practice location
1112 W 6TH St
Suite 124
Lawrence, KS 66044-2215
Mailing address
1112 W 6TH St
Suite 124
Lawrence, KS 66044-2215
Phone (785) 843-9125
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104830 | KS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409184000000",
"number": "1164822003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1112 W 6TH ST",
"address_2": "SUITE 124",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660442215",
"telephone_number": "785-843-9125",
"fax_number": "785-843-0032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1112 W 6TH ST",
"address_2": "SUITE 124",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660442215",
"telephone_number": "785-843-9125",
"fax_number": "785-843-0032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONNEL",
"first_name": "DEVA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-28",
"last_updated": "2014-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "1104830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.