Kathryn Bonner, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT3942 Issued in MS

Practice address

1990 S Frontage Rd Ste J
Vicksburg, MS 39180-5232

Phone

(601) 883-1983

Fax

(601) 883-1938

NPI assigned

Nov 5, 2007

Last updated

Nov 5, 2007By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Performance and Rehab, LLCGroup PAC ID 8729361076, 5 clinicians

Practice addresses (Care Compare)

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.

• Elite Performance and Rehab, LLC

  • Physical Therapy Clinic/Center
  • Vicksburg, MS
  • NPI 1255877346

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Diagnostic Testing Solutions

  • Physiological Laboratory
  • Vicksburg, MS
  • NPI 1154746154
  NPD (past)
• Good Samaritan Physical Therapy,Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Vicksburg, MS
  • NPI 1023087855
  NPD (past)

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

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1659551802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 S FRONTAGE RD STE J",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805232",
            "telephone_number": "601-883-1983",
            "fax_number": "601-883-1938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 S FRONTAGE RD STE J",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805232",
            "telephone_number": "601-883-1983",
            "fax_number": "601-883-1938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNER",
        "first_name": "KATHRYN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-05",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT3942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bladder Control Solutions, Inc
• Tempie Bland, LCSW
• Blue River Healthcare, Inc
• Bold Touch Home Health Services
• Miriam Bond
• Karen Bourne
• Coty Bourque, LCSW
• Courtney Boutwell
• Melissa Denise Bowman, LPN
• Rebecca Lauren Boyd

• Physical Therapist in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.