Bonita Lynn Despain, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A2779 Issued in MN

Practice address

2201 Keenan Dr
International Falls, MN 56649-2152

Phone

(218) 283-8313

NPI assigned

Sep 18, 2015

Last updated

May 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Mrs. Bonita Lynn McKeag Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Evangelical Lutheran Good Samaritan Society

  dba Good Samaritan Society - International Falls

  • Skilled Nursing Facility
  • International Falls, MN
  • NPI 1427033810
  NPD (past)
• The Evangelical Lutheran Good Samaritan Society

  dba Good Samaritan Society - Hospice

  • Community Based Hospice Care Agency
  • Hastings, NE
  • NPI 1255165791
  NPD (past)

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1588033658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 7TH ST # 1",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492619",
            "telephone_number": "309-502-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 KEENAN DR",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492152",
            "telephone_number": "218-283-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESPAIN",
        "first_name": "BONITA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-18",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2015026804",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.005650",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A2779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BONITA",
            "last_name": "MCKEAG",
            "middle_name": "LYNN",
            "prefix": "MRS.",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Corrin Dental PLLC
• County of Koochiching (Koochiching County Health Department)
• Dean Christopher Cowman, DC
• Samantha Ann Crossley
• Jacelyn Paige Davidson, M.D.
• Whitney Lee Donner
• E L Anderson City Drug Store (City Drug)
• Essentia Health Virginia, LLC (Essentia Health International Falls Clinic)
• Essentia Health Virginia, LLC (Essentia Health International Falls Clinic)
• Falls Advanced Chiropractic Center

• Physical Therapy Assistant in International Falls, MN
• Providers in International Falls, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.