Roberto M. Bonnevie Jr., P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

18452 Issued in MD

Practice address

11325 Pembrooke SQ Ste 115
Waldorf, MD 20603-4807

Phone

(301) 358-6155

NPI assigned

Jun 17, 2009

Last updated

Dec 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• LHMG Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Annapolis, MD
  • NPI 1396122842

  Physical Therapist

  Medicare reassignment NPD
• LHMG Physical Therapy, LLC

  • Physical Therapist
  • Bowie, MD
  • NPI 1750769055

  DC

  Medicare reassignment NPD
• LHMG Physical Therapy, LLC

  dba AAMG Physical Therapy Cape St. Claire

  • Physical Therapist
  • Annapolis, MD
  • NPI 1134763212
  NPD
• LHMG Physical Therapy, LLC

  • Physical Therapist
  • Upper Marlboro, MD
  • NPI 1982214490
  NPD

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

{
    "created_epoch": "1245196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1588891584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11325 PEMBROOKE SQ STE 115",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034807",
            "telephone_number": "301-719-1146",
            "fax_number": "301-645-5343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11325 PEMBROOKE SQ STE 115",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034807",
            "telephone_number": "301-358-6155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5801 Allentown Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Suitland",
            "state": "MD",
            "postal_code": "207464561",
            "country_code": "US",
            "telephone_number": "240-842-1435",
            "fax_number": "240-318-2232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONNEVIE",
        "first_name": "ROBERTO",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-17",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "18452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "584102000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Boateng
• Gregory Richard Bob, DDS
• Therese Jean Bohannon, RN
• Fese E Bokosah
• Grace Bolomope, OTD, OTR/L
• Taylor A Bordes, DDS
• Michelle D Borrus, D.D.S
• Laurie Ann Bosak, RD
• Titiana Regine Boti Bi
• Bowen Psychological Services, LLC

• Physical Therapist in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; 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.